Cycling suturing and knot-tying device

ABSTRACT

A cycling suturing and knot-tying device is characterized by an arcuate fixed, grooved or recessed way provided in a correspondingly-shaped support frame for accommodating a curved needle fitted with thread, and frictional needle-engaging devices provided in the way for selectively engaging the needle and driving the needle in one or both rotational directions to suture a wound with the thread. Selective articulation of the frame and the way and driving of the needle in the way by positioning the frictional needle-engaging devices with respect to the needle are typically effected by manipulation of a pistol-grip operating apparatus having a transmission tube that mounts the frame and the way in articulating relationship and rotates and articulates with respect to the pistol grip and carries various operating elements that interface with the frictional needle-engaging devices in the way. In at least one embodiment needle direction-adjusting elements are provided in the frame in cooperation with selected devices in the way for determining the direction of needle rotation responsive to manipulation of an interfacing operating element located on the operating apparatus. Auxiliary thread-handling or incrementing and knot-tying devices are also disclosed.

This is a Continuation-In-Part of application Ser. No. 10/263,902 filedOct. 3, 2002 now U.S. Pat. No. 7,004,951.

BACKGROUND OF THE INVENTION Field of the Invention

This invention relates to the suturing of surgical incisions, wounds andany other joining or fixing of tissue in general surgical procedures andin particular, the suturing, joining or binding of tissue in surgicalprocedures involving very small, cramped or otherwise inaccessiblefields of operation, such as in general laparoscopic and neurologicalbrain surgery. One of the problems which is inherent in many surgicalprocedures is that of limited access of the surgeon's hands, as well asthe needle and suturing implements, into the incision or wound. Thisproblem is amplified under circumstances where delicate surgery such asheart, brain, and spinal surgery, as well as surgery on infants andchildren is undertaken, since the surgical areas of interest involveminute features. Many surgical procedures that would otherwise bepossible on adults and children are impossible due to the tiny operatingfields and many conditions that might otherwise be corrected by surgeryare therefore considered to be inoperable. The same situation occursunder circumstances such as suturing within interior and normallyinaccessible areas of the body, where no known surgical techniquesand/or instruments can access these areas and provide the necessarysurgical relief.

The micro-sized cyclical suturing and knot-tying device of thisinvention is designed to optimize surgical suturing and in particular,to facilitate access to very small, normally, but not limited to,inaccessible areas of the body, including the heart, brain and spinalcord, as well as conventional procedures on infants, to allow surgicalrelief which has heretofore been unavailable by conventional surgicaltechniques. The device of this invention is characterized by an arcuate,fixed, grooved or recessed way provided in a correspondingly configuredsupport frame mounted for articulation on an operating device andcapable of receiving a rotating, curved needle fitted with a length ofthread. Frictional devices are provided in the way for selectivelyengaging the needle and causing the needle to rotate in either directionfor suturing a wound, which can be operated with sufficient force in anarticulated state. These frictional devices are responsive tomanipulation of various operating elements or components in theoperating device. Needle direction-adjusting elements can also beprovided in the frame for selectively adjusting the direction of needlerotation. Articulation of the support frame that carries the way and therotating needle with respect to the operating device is typicallyfacilitated by means of cables connecting the ball or universaljoint-mounted frame to a “joy stick”-type lever provided on theoperating device. Accordingly, rotation of the needle incrementally inone or both directions can be effected by manipulation of theappropriate directional and drive operating elements on the operatingdevice, and articulation of the frame, and thus the way and the needlein concert, by manipulation of the lever on the operating device.Various thread incrementing and handling accessories and hook/unhookknot-tying devices can also be utilized in cooperation with theoperating device to facilitate pulling, handling and tying of the threadto define suturing knots as the tissue suturing is effected by theoperating device and the rotating needle.

The curved or arcuate frame is constructed to support the needle fromend to end when the needle is in the starting position. The arcuategrooved or recessed support way is shaped in such a manner as to providethe correspondingly-shaped needle with adequate support while leavingthe top of the groove or recess, located on the top of the disk ofrotation open to permit passage of the thread around the way circuittraversed by the needle without trapping the thread in any of the needlesupport and drive structure. All friction and locking forces are appliedby means of the frictional devices to the needle at selected locationson the way. Both the needle and the frame, as well as the way, have acorresponding gap to accommodate tissue to be sewn. Accordingly, whenthe needle is driven in a circular path by manipulation of theappropriate operating components or elements in the operating device,the needle passes through tissue which protrudes into the gap in theway. Furthermore, since the thread is attached to the needle, either atone end of the needle, in the case of unidirectional needle motion, orin the case of bidirectional needle operation in the center of theneedle, the thread is drawn behind the needle, around the open top ofthe way, across the gap and through the tissue as the needle traversesthe tissue. Although the thread cannot be trapped within the way, it isentrapped within the tissue through which the needle and thread ispassed. If this penetration and entrapment is followed by successiveencirclements of segments of the trailing portion or tail of the threadby the leading portion or head of the thread, where it joins the needle,rather than penetrating the tissue, then a knot is formed, which may bedrawn tight and will bind in the same manner as a conventionalsurgically tied knot. It is significant that all of the knots commonlyused in conventional surgery may be tied in this manner by use of thedevice of this invention in a fraction of the time required byconventional sewing and knotting techniques.

Various elements and components are provided in the operating device incooperation with the way, the needle and the support frame for effectingrotation of the needle in one or both directions responsive tomanipulation of the operating device. Typical of the needle drivedevices is a needle driver and a drive direction setting platecombination mounted in the support frame, such that the drive directionsetting plate and needle driver may be manipulated in sequence by thecorresponding operating elements or components in the operating deviceto set the direction of rotation of the needle and then drive the needlein that direction. A second drive mechanism includes a rack and pinionmechanical arrangement that typically moves the needle in one directionresponsive to operation of the operating device. A third drive mechanismincludes multiple forked blades that rotate within the frame bymanipulation of the operating device to engage the blade and operate theblade in a selected direction by means of a driver plate. Anotherdriving mechanism for causing the needle to traverse the way in aselected direction is provided by multiple, fork-shaped blades thatselectively engage the needle responsive to a drive spur device operatedby the operating device. Yet another driving mechanism includes aplanetary wheel and gear mechanism operated by a pair of beveled gearsthat drive toothed rotors for engaging and driving the needle. Auniversal joint arrangement typically connects the support frame to theoperating device in but not limited to this embodiment of the invention.Another embodiment of the needle articulation and drive mechanismincludes a flexible rotor that selectively engages the needle and isdriven responsive to operation of the operating device. Still anotherdrive mechanism for causing the needle to traverse the way in anarticulating, controlled manner is a pawl and crank device whichincludes a pawl mounted in the frame and a cooperating crank that ridesin a V-shaped slot in the pawl to effect selective engagement of theneedle by the pawl teeth and rotation of the needle in the way bymanipulation of the operating device. Various operating devices may beutilized to interact and interface with the respective drive mechanismsfor traversing the needle around the way in the frame in anarticulating, controlled manner, as hereinafter described.

SUMMARY OF THE INVENTION

These and other objects of the invention are provided in a suturingdevice which includes an arcuate frame having an open groove; an arcuateneedle disposed within the frame and seated in the groove; engagingmeans disposed within the frame and selectively extending into thegroove for releasably engaging the needle; and drive means engaging theengaging means for driving the needle in the groove.

An object of one form of the invention is to provide a suturing devicewhich comprises a uniquely configured articulating suturing head thatincludes a plurality of strategically shaped, circumferentially-spacedcavities, a generally semicircular-shaped shuttle track along which anovel needle advancing shuttle is slidably movable and a generallysemicircular-shaped needle guide along which a novel suturing needle issequentially advanced by movement of the needle advancing shuttle.

Another object of one form of the invention is to provide a suturingdevice of the character described in the preceding paragraph whichincludes a suturing needle that has a novel rectangular cross section, acircumferentially extending, notched wall and a strategically angledchamfered end that compensates for needle deformation in the suturingprocess.

Another object of one form of the invention is to provide a suturingdevice of the aforementioned character, which includes a plurality ofuniquely configured needle engaging and advancing members that aredisposed within the plurality of strategically shaped,circumferentially-spaced cavities formed in the articulating suturinghead portion and are adapted for both transverse and pivotal movementwithin the cavities in response to movement of the needle advancingshuttle.

Another object of one form of the invention is to provide a suturingdevice of the character described in the preceding paragraphs whichcomprises a dual-cable shuttle advancing subsystem that includes acooperating biasing spring and trigger mechanism for smoothly andpositively moving the needle advancing shuttle along the shuttle trackof the suture head of the device.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a right-side perspective view of a preferred embodiment of acyclical suturing and knot-tying operating device, generallyillustrating a handle; a housing to which the handle is attached; atransmission tube mounted on a cradle pivotally carried by the housing;a cable lever mounted on one end of the transmission tube formanipulating articulation cables extending through the transmission tubeand connecting to the arcuate frame. A slide switch is illustrated and adirection actuator mounted on the transmission tube forwardly of thehandle, which extends into the tube and attaches to the one of the twocable circuits which sets the direction of the needle movement. Anextension tube extending from the opposite end of the transmission tubefrom the lever further encloses the articulation cables and cablecircuits and supports an arcuate needle frame or crescent positioned onthe end of the extension tube for receiving the cables, mounting thecurved needle and effecting suturing of tissue responsive to operationof the lever and the articulating and needle control elements of theoperating device.

FIG. 2 is a rear perspective view of the operating device illustrated inFIG. 1, more particularly illustrating articulation of the crescent, theextension tube and the housing and housing cradle to the left withrespect to the handle.

FIG. 3 is a left side perspective view of the operating deviceillustrated in FIGS. 1 and 2.

FIG. 4 is a top and left side perspective view of the operating deviceillustrated in FIGS. 1-3, more particularly illustrating a second handletransversely attached to the first handle and including an auxiliaryoperating tube extending from the second handle to a thread incrementingaccessory attached to the crescent.

FIG. 5 is an enlarged view of the crescent and the crescent-mount end ofthe extension tube extending from the transmission tube illustrated inFIGS. 1-4, more particularly illustrating a curved needle rotatablyseated in the crescent and a ball which engages a crescent socket andmounts the crescent on the extension tube to facilitate articulation ofthe crescent responsive to operation of the lever illustrated in FIGS.1-4.

FIG. 6 is an exploded view of the various fixed and rotatable drivecomponents of the crescent for driving the needle in the crescent anddetermining the direction of needle rotation responsive to operation ofcorresponding operating components or elements in the operating device.

FIG. 6A is a top perspective view, partially in section, of one end ofthe crescent illustrated in FIG. 6 in assembled configuration with thefixed way removed for brevity, more particularly illustrating therespective needle driver, drive direction setting plate, fixed waydirection setting plate and case for suspending and driving the curvedneedle.

FIG. 6B is a bottom perspective view, partially in section, of therespective blade supporting and driving components illustrated in FIG.6A, more particularly illustrating cable extension elements forreceiving direction and drive cables in the operating device.

FIG. 7 is a top perspective view of the needle driver element of thecrescent, more particularly illustrating a system of two sets ofoppositely-disposed needle-engaging blades for selectively engaging anddriving a curved needle seated in the arcuate needle driver, responsiveto operation of various operating elements in the operating device.

FIG. 7A is a perspective view of a typical needle-engaging bladeillustrated in FIG. 7.

FIG. 7B is a top view, partially in section, of a pair ofoppositely-disposed blades illustrated in FIG. 7, more particularlyillustrating a blade bevel on each blade designed to efficiently andsequentially engage the needle and selectively drive the needle in theforward or reverse direction.

FIG. 8 is a top perspective view of one end of the drive directionsetting plate component of the crescent, more particularly illustratingtwo sets of spaced-apart, oppositely-disposed, needle-engaging bladesfor sequentially engaging the needle and determining the direction ofrotation of the needle responsive to operation of blade-positioningoperating components in the operating device.

FIG. 8A is an enlarged top view of the needle driver and the underlyingdrive direction setting plate, more particularly illustrating engagementof one set of oppositely-disposed needle-engaging blades positioned inblade group housing of the needle driver by the drive direction settingplate, for driving the needle in the indicated direction responsive tooperation of needle-driving operating components in the operatingdevice.

FIG. 8B is a top view of the opposite end of the needle driver and drivedirection plate as illustrated in FIG. 8A, more particularlyillustrating engagement of the second set of oppositely-disposed bladesin the needle driver by the drive direction plate, for driving theneedle in the opposite direction as indicated, responsive to operationof the needle-driving operating elements in the operating device.

FIG. 9 is an enlarged bottom perspective view of one end of the needledriver, more particularly illustrating extension of the respectiveneedle-engaging blade sets through slots in the needle driver forengagement by corresponding openings in the underlying drive directionsetting plate (not illustrated) to determine the direction of rotationof the needle.

FIG. 10 is an enlarged bottom perspective view of the one end of theneedle driver and the drive direction setting plate, more particularlyillustrating engagement of the downwardly-extending ends of the bladeswith the respective walls of parallelogram-shaped slots provided in thedrive direction setting plate, for manipulation of the drive directionsetting plate by blade direction components or elements in the operatingdevice and determining the direction of rotation of the needle.

FIG. 11 is a perspective view of the needle driver and the drivedirection setting plate in functional connection, more particularlyillustrating a pair of cable mount extensions projecting downwardly fromthe drive direction setting plate and the needle driver, respectively,for operating the needle driver and the drive direction setting plate toboth drive the needle and determine the direction of needle rotation,responsive to operation of the respective connecting element controlfunctions of the operating device.

FIG. 11A is a bottom view of one end of the needle drive directionsetting plate, more particularly illustrating the respective sets ofparallelogram slots for receiving the projecting ends of thecorresponding blades from the needle driver and the curved tab clearanceslots for accommodating and operating the two cable mount extensions onthe needle driver in the crescent.

FIG. 12 is a bottom perspective view of the needle driver, moreparticularly illustrating the two spaced-apart cable mount extensionsfor attachment to cables (not illustrated) and manipulating the needledriver by operation of the appropriate blade control components in theoperating device.

FIG. 12A is an enlarged bottom perspective view of one end of the needledriver, more particularly illustrating downward projection of theneedle-engaging blades through corresponding slots in the needle driverand the relative position of one of the cable mount extensions attachedto the needle driver for moving the needle driver and the needle andadjusting the blades responsive to operation of the respective controlcomponents or elements in the operating device.

FIG. 13 is a bottom perspective view of one end of the needle drivedirection setting plate and the needle driver, more particularlyillustrating the parallelogram slots provided in the needle drivedirection setting plate for receiving the ends of thedownwardly-extending needle-engaging blades from the needle driver (FIG.12A), and more particularly illustrating downward projection of a driveaccess cable extension from the needle driver through a first curvedslot in the drive direction setting plate for operating the needledriver. Further illustrated is downward extension of a direction settingaccess cable extension attached to the drive direction setting plate,with cables attached to the drive access cable extension and thedirection setting access cable extension for operating both thedirection of travel of the needle and needle rotation, responsive tomanipulation of the appropriate operating controls in the operatingdevice.

FIG. 13A is a bottom perspective view of one end of the drive directionsetting plate mounted below the needle driver and including the fixedway, also mounted above the needle driver, for setting the direction ofrotation of the needle and driving the needle by means of cables securedto the underlying drive access cable extension and direction accesscable extension, respectively.

FIG. 14 is a bottom perspective view of one end of the drive directionsetting plate, needle driver and fixed way (absent the fixed way housing104A) combination illustrated in FIG. 13, along with one end of thefixed way direction setting plate element of the crescent.

FIG. 15 is a bottom perspective view of the combination illustrated inFIG. 14 along with the case illustrated in FIG. 6, more particularlyillustrating the downward extension of the drive access cable extensionand the direction setting access cable extension, both projectingthrough a corresponding curved operating slot in the case and attachedto cables for extension to the respective needle direction setting anddrive controls provided on the operating device.

FIG. 16 is a bottom perspective view of the fixed way illustrated inFIG. 6.

FIG. 17 is a top perspective view of the fixed way illustrated in FIG.16.

FIG. 18 is a top perspective view of the needle fixed way directionsetting plate disposed between the drive direction setting plate and thecase illustrated in FIG. 6.

FIG. 18A is a top perspective view of one end of the needle fixed waydirection setting plate illustrated in FIG. 18.

FIG. 19 is a perspective view of one end of the fixed way mounted on theneedle fixed way direction setting plate, more particularly illustratinga typical entrance stop and range stop provided on the fixed way drivedirection setting plate, for limiting its travel caused by motion of thedrive direction setting plate's travel (not illustrated) in determiningthe direction of rotation of the needle.

FIG. 20 is a top view of one end of the needle fixed way directionsetting plate illustrated in FIG. 19, disposed on the case asillustrated in FIG. 6, more particularly illustrating a clockwisedirection of motion of the needle drive direction setting plate withrespect to the case for setting the fixed way direction plate inposition to allow a counterclockwise direction of rotation of the needlein the crescent.

FIG. 21 is a top view of one end of the needle drive direction settingplate illustrated in FIG. 20, more particularly illustrating the fixedway drive direction plate set into a counterclockwise allowing positionwith respect to the rotation of the needle in the crescent.

FIG. 22 is a top perspective view of the fixed way, needle driver,needle drive direction setting plate and the fixed way direction settingplate illustrated in FIG. 6, more particularly illustrating assembly ofthese components.

FIG. 22A is a bottom perspective view of the assembled fixed way, needledriver, needle drive direction setting plate and the fixed way directionsetting plate assembly illustrated in FIG. 22.

FIG. 23 is a bottom perspective view of one end of the assembled fixedway, needle driver, drive direction setting plate and fixed waydirection setting plate assembly illustrated in FIG. 6.

FIG. 24 is a bottom perspective view of the assembled fixed way, needledriver and drive direction setting plate underlying the needle driver,which needle driver is seated on the fixed way for selectively driving acurved needle around the crescent in a counterclockwise rotationalsequence.

FIG. 25 is a bottom perspective view of the assembled fixed way, drivedirection setting plate, needle driver and fixed way, with the needledriver gripping the needle and rotated with the drive direction settingplate on the fixed way for driving one end of the crescent-shaped needleinto the crescent slot for suturing tissue.

FIG. 26 is a perspective bottom view of the assembled drive directionsetting plate, needle driver and fixed way, with the drive directionsetting plate and needle driver reversed in direction from thatillustrated in FIG. 25 and the needle released by the needle driver, toa position for beginning a second incremental rotation of the needleinto the crescent slot.

FIG. 27 is a perspective bottom view of the assembled drive directionsetting plate, needle driver and fixed way, more particularlyillustrating sequential reversal of the direction of rotation of theneedle driver and the drive direction setting plate and engagement ofthe needle by the needle driver, for another incremental rotation of theneedle into the crescent slot.

FIG. 28 is a bottom perspective view of the assembled drive directionsetting plate, needle driver and fixed way, more particularlyillustrating an additional incremental rotation of the drive directionsetting plate to extend the needle around the crescent and through thecrescent slot.

FIG. 29 is a bottom perspective view of the assembled drive directionsetting plate, needle driver and fixed way, wherein the drive directionsetting plate and the needle driver have been reversed and the needlereleased for a final incremental driving of the needle back to theposition illustrated in FIG. 24.

FIG. 30 is a top view of the needle fixed way direction setting plateand drive direction setting plate (hidden by the fixed way directionsetting plate) superimposed on the bottom of the needle driver and thefixed way, with the fixed way overhead connecting members removed forbrevity.

FIG. 31 is a top view of the fixed way direction setting plate and drivedirection setting plate superimposed on the bottom of the needle driverand the fixed way illustrated in FIG. 30, further illustrating theincremental movement distance of the needle driver and the drivedirection setting plate with respect to the fixed way direction settingplate on the fixed way.

FIG. 32 is a top view of the fixed way direction setting plate and thedrive direction setting plate superimposed on the bottom of the needledriver and the fixed way illustrated in FIG. 31, illustratingincremental motion in one direction of the needle driver, the drivedirection setting plate and the fixed way direction setting plate withrespect to the fixed way.

FIG. 33 is a top view of the fixed way direction setting plate and thedrive direction setting plate superimposed on the bottom of the needledriver and the fixed way illustrated in FIG. 32, further illustratingthe final position of the fixed way direction setting plate with respectto the fixed way for determining the clockwise direction of needlerotation.

FIG. 34 is a top view of the fixed way direction setting plate and thedrive direction setting plate superimposed on the bottom of the needledriver and the fixed way illustrated in FIGS. 30-33, illustratingreverse incremental motion of the drive direction setting plate and thefixed way direction setting plate with respect to the fixed way forreversing rotation of the needle in the crescent.

FIG. 35 is a top view of the fixed way direction setting plate and thedrive direction setting plate superimposed on the bottom of the needledriver and the fixed way illustrated in FIGS. 30-34, furtherillustrating the final position of the drive direction setting plate andthe fixed way direction setting plate with respect to the fixed way fordetermining the counterclockwise direction of needle rotation.

FIG. 36 is an enlarged top view of one end of the needle driver, thedrive direction setting plate, the fixed way direction setting plate andthe case, more particularly illustrating the case bosses and detentsprovided in the case and the fixed way needle direction setting plate,for determining the range of motion of the fixed way direction settingplate with respect to the case and counterclockwise rotation of theneedle in the crescent.

FIG. 37 is a top view of the needle driver, the drive direction settingplate, the fixed way direction setting plate and the case illustrated inFIG. 36, more particularly illustrating engagement of a case boss with adetent in the fixed way direction setting plate for determiningcounterclockwise travel of the needle with respect to the case.

FIG. 38 is a top view of the opposite end of the needle driver, theneedle drive direction setting plate, the fixed way direction settingplate and the case, further illustrating the travel relationship betweenthe fixed way direction setting plate with respect to the case to setthe needle rotation in the clockwise direction.

FIG. 39 is a top view of the needle driver, the drive direction settingplate, the fixed way direction setting plate and the case illustrated inFIG. 38, more particularly illustrating travel mode of the needle in thecounterclockwise direction with respect to the case.

FIG. 40 is a bottom view of the crescent, mounted in articulating balland socket relationship on a transition guide cone provided on one endof the extension tube extending from the transmission tube, witharticulation control cables extending through the extension tube to thecrescent at the ball and socket mount between the crescent and thetransition guide cone.

FIG. 40A is a top and front perspective view of the crescent andextension tube mount illustrated in FIG. 40, more particularlyillustrating the positioning of a length of thread on the midpoint ofthe curved needle and a thread incrementing accessory mounted on one endof the crescent to increment and handle the thread.

FIG. 41 is a perspective view of the cyclic suturing and knot-tyingoperating device illustrated in FIGS. 1-4, more particularlyillustrating typical cable arrangements extending through thetransmission tube, the extension tube and the transition guide cone fromthe lever to the crescent, for articulating the crescent on the end ofthe transition guide cone and controlling operation of the needledriver, the needle drive direction setting plate and the fixed waydirection setting plate in the crescent.

FIG. 42 is a perspective view of the handle element of the operatingdevice illustrated in FIGS. 1-4, more particularly illustrating thehandle trigger, housing and cradle elements, the cradle of whichreceives the transmission tube, illustrated in phantom.

FIG. 43 is a perspective view of the handle illustrated in FIG. 42, withthe housing rotated to facilitate multiple positioning of thetransmission tube (illustrated in phantom) mounted in the cradle.

FIG. 44 is a perspective view of the handle, cradle and housing, moreparticularly illustrating additional rotation of the housing, cradle,and transmission tube with respect to the handle.

FIG. 45 is a perspective view of the handle, housing and cradlecomponents of the operating device, further illustrating pivoting of thecradle and transmission tube with respect to the housing and handle.

FIG. 46 is a top view of the handle, cradle and housing combinationillustrated in FIG. 45, with the transmission tube removed.

FIG. 47 is a side sectional view, taken along line 48-48 of the handleand housing in FIG. 46, more particularly illustrating aneedle-operating trigger and sprocket combination mounted in the handleand housing, respectively.

FIG. 48 is an enlarged perspective view of a trigger and sprocket gearengagement to drive a sprocket by manipulation of the trigger in thehandle illustrated in FIGS. 42-46.

FIG. 49 is a perspective view of the trigger and upper teeth provided onthe trigger for engaging the sprocket gear illustrated in FIG. 48 anddriving the sprocket responsive to manipulation of the trigger.

FIG. 50 is an enlarged side perspective view of the handle, trigger,housing, cradle and transmission tube mounted in the cradle.

FIG. 51 is an enlarged, side view of the handle, trigger, cradle andtransmission tube with the housing removed, more particularlyillustrating fitting of the trigger through an opening in a base memberof the housing and positioning the sprocket to engage a reciprocationinput collar slidably mounted on the transmission tube.

FIG. 52 is a bottom perspective view of the handle, trigger, housing,cradle and transmission tube elements of the device, more particularlyillustrating a typical trigger clearance opening in the housing.

FIG. 53 is a side sectional view of the trigger, cradle, sprocket gearand sprocket combination, interfaced with the respective operatingelements of the reciprocating input collar slidably mounted on thetransmission tube, and the trigger disengaged from the sprocket gear.

FIG. 54 is a side sectional view of the trigger cradle, sprocket gearsand sprocket combination interfaced with the respective operatingelements of the reciprocating input collar, slidably mounted on thetransmission tube, and the trigger engaged with the sprocket gear.

FIG. 55 is a side sectional view of the trigger, cradle, sprocket gearand sprocket combination interfaced with the respective operatingelements of the reciprocating input collar slidably mounted on thetransmission tube and the trigger fully pulled to rotate the sprocketgear and sprocket and slide the reciprocating input collar on thetransmission tube.

FIG. 56 is an enlarged longitudinal sectional and perspective view ofthe transmission tube and the internal needle-operating cables andsprocket trigger mechanism operated by the trigger.

FIG. 57 is a transverse sectional view of the transmission tube and theinternal cables and trigger mechanism operated by the trigger at thereciprocating input collar to control needle rotation in the crescentillustrated in FIG. 56.

FIG. 58 is an exploded view of the lever and lever cable support andmount assembly for manipulating the crescent on the end of the extensiontube.

FIG. 59 is a bottom view, partially in section, of the crescent and thecrescent ball mounted on the extension tube and seated in the socket inthe crescent, and including a preferred cable network extending from theoperating elements or components in the transmission tube to articulatethe crescent on the end of the extension tube and operate the needledriver, drive direction plate and needle direction plate in thecrescent.

FIG. 60 is a bottom view, partially in section, of the extension tubeand the crescent mounted in articulating relationship on the end of theextension tube illustrated in FIG. 59, along with a typical operatingcable system for manipulating the crescent with respect to the extensiontube and illustrating the drive access cable extensions and clearancetunnels for connection to the operating components of the operatingdevice and operating the needle driver in the crescent.

FIG. 61 is a sectional view of the transition cone and spacer ringelements of the device, which transition cone joins the transmissiontube to the extension tube and narrows the internal cable run betweenthe transmission tube and the extension tube.

FIG. 62 is a perspective view of the extending end of a short extensiontube and the crescent mounted in articulating relationship on thetransition guide cone on the extension tube, by means of a ball andsocket arrangement and more particularly illustrating articulation ofthe crescent with respect to the extension tube by operation of a pairof cables extending from the crescent to the lever illustrated in FIGS.1-3.

FIG. 63 is a side view, partially in section, of the crescent, thecrescent socket provided in one end of the crescent and the cooperatingball provided on the transition guide cone on the extending end of theextension tube and seated in the crescent socket, more particularlyillustrating a typical cable arrangement extending through thetransition guide cone to the crescent for articulating the crescent to afirst position.

FIG. 64 is a side view, partially in section, of the crescent, thecrescent socket provided in one end of the crescent and the cooperatingball provided on the extending end of the transition guide cone on theextension tube and seated in the crescent socket illustrated in FIG. 63,more particularly illustrating a second articulated position of thecrescent.

FIG. 65 is an enlarged perspective view, partially in section, of theexternal and internal components of the needle direction actuator andthe slide switch operating components mounted on the transmission tubeof the operating device.

FIG. 66 is an enlarged longitudinal sectional view of the external andinternal components of the direction actuator and the slide switchoperating components of the operating device illustrated in FIG. 65.

FIG. 67 is an enlarged longitudinal sectional view of the external andinternal components of the direction actuator and the slide switchoperating components of the operating device illustrated in FIG. 66,with the direction actuator positioned in an alternative functionalconfiguration.

FIG. 68 is a transverse sectional view of the transmission tube, takenat the direction actuator, more particularly illustrating internalelements of the lever mechanism and the direction actuator locatedinside the transmission tube.

FIG. 69 is a perspective view of an actuator boss element of thedirection actuator assembly.

FIG. 70 is a perspective view of a direction connecting rod element ofthe direction actuator assembly.

FIG. 71 is a front view of the direction connecting rod elementillustrated in FIG. 70.

FIG. 72 is a perspective view of a reciprocation input collar element ofthe direction actuator assembly.

FIG. 73 is a perspective view of a slide switch mount body element ofthe slide switch element of the operating device.

FIG. 74 is a perspective view of a forked transmission rod element ofthe slide switch.

FIG. 75 is a perspective view, partially in section, of the needledirection actuator mechanism slidably mounted on the transmission tubeand including a set of cables extending through the transmission tubeand around pulleys mounted on inserts provided in the transmission tube,for extension to the crescent.

FIG. 76 is a sectional view of the insert and pulley assembly, assembledfor mounting in the transmission tube, with the drive cable anddirection cable extending around the respective pulleys in the inserts.

FIG. 77 is a perspective view of the inserts illustrated in FIG. 76,illustrating one of the pulleys mounted internally therein and moreparticularly illustrating cable slots for receiving the various crescentarticulation cables extending through the transmission tube.

FIG. 78 is a perspective view of the insert, pulley and cablearrangements illustrated in FIGS. 75 and 76, extending around thepulleys and through the insert slots inside the transmission tube.

FIG. 79 is a perspective view of a selection bearing that cooperateswith the lever illustrated in FIGS. 1-3 and illustrating crescentarticulation cables mounted in the selection bearing to facilitateoperation of the lever and the cables and articulate the crescent on theextension tube responsive to manipulation of the lever.

FIG. 80 is a perspective view of the crescent in close proximity totissue to be sutured, more particularly illustrating operating of theoperating device and crescent to suture the tissue.

FIG. 81 is a perspective view of the crescent illustrated in FIG. 80,illustrating a preferred manipulation and incrementing of threadtypically centered on the curved needle using the thread incrementingdevice during a suturing operation.

FIG. 82 is a perspective view of the crescent, illustrating a preferredmanipulation of the thread illustrated in FIG. 81 in a looping operationto facilitate stitching the tissue while using the operating device andcrescent with the thread incrementing device.

FIG. 83 is a perspective view of a suture knot, illustrating theknotting of two lengths of thread to attach adjacent segments of tissueduring the suturing process using the crescent.

FIG. 84 is a front perspective view of a preferred embodiment of thethread incrementing accessory that handles and increments the thread inthe cycling suturing and knot-tying device of this invention.

FIG. 85 is a rear perspective view of the thread incrementing accessoryillustrated in FIG. 84.

FIG. 86 is a side view, partially in section, of the thread incrementingaccessory illustrated in FIGS. 84 and 85.

FIG. 87 is a top perspective view of the thread incrementing accessoryillustrated in FIGS. 84-86, more particularly illustrating mounting ofthe thread incrementing accessory on one end of the crescent.

FIG. 88 is a top view of the crescent element of the cycling suturingand knot-tying device, with the thread incrementing accessory mounted onone end thereof, more particularly illustrating positioning of a lengthof thread extending from the needle in the crescent, through the threadincrementing accessory and through a tissue subjected to suturing, priorto operation of the thread incrementing accessory.

FIG. 89 is a top view of the crescent illustrated in FIG. 88, with athread incrementing accessory located on each end of the crescent and alength of thread extending from the needle through both threadincrementing accessories and through tissue to be sutured.

FIG. 90 is a side sectional view of the thread incrementing accessoryillustrated in FIG. 87.

FIG. 90A is a side sectional view of the thread incrementing accessoryillustrated in FIG. 90 illustrating the thread incrementing accessory inneutral configuration.

FIG. 90B is a side sectional view of the thread incrementing accessoryillustrated in FIG. 90A, with the actuation plate incremented forwardlywith no gripping of the thread.

FIG. 90C is a side sectional view of the thread incrementing accessoryillustrated in FIGS. 90A and 90B, with the actuation plate incrementedrearwardly, with gripping of the thread.

FIG. 91 is a bottom perspective view of the thread incrementingaccessory illustrated in FIG. 90, more particularly illustrating anaccess extension tab and a cable connection in the thread incrementingaccessory.

FIG. 92 is a perspective view of the housing and base elements of thethread incrementing accessory illustrated in FIG. 91.

FIG. 93 is a perspective view of the thread incrementing accessorymovable housing element illustrated in FIG. 90, more particularlyillustrating blade recesses and fin slots in the movable housing.

FIG. 94 is an exploded view of the movable housing and actuation plateassembly of the thread incrementing accessory, more particularlyillustrating the extension of multiple blade tabs extending throughcorresponding clearance holes in the movable housing and through theparallelogram holes in the actuation plate.

FIG. 95 is a perspective view of a typical thread-engaging movable bladefor use in the thread incrementing accessory illustrated in FIG. 84.

FIG. 96 is a bottom perspective of the actuation plate illustrating thetab of the movable blade in the parallelogram hole, more particularly,the triangular shape of the tab at its lower end where it contacts theangled wall of the parallelogram hole.

FIG. 96A is a diagram of incrementor blade tabs extending throughparallelogram holes in the movable housing in close proximity to theneedle thread.

FIG. 96B is an enlarged diagram of a blade tab illustrated in FIG. 96A.

FIG. 96C is a diagram of the blade tab, illustrating the tab andparallelogram holes before contact illustrated in FIG. 96B, and furtherillustrating contact between the blade tab and the angled walls ofparallelogram holes, which caused the blade to bend in toward the threadand contact it.

FIG. 97 is a side view, partially in section, of the thread incrementingaccessory, more particularly illustrating handling of a length of threadextending from tissue which is sutured and located in close proximity tothe thread incrementing accessory.

FIG. 98 is a perspective view of the crescent end of the cyclingsuturing and knot-tying device, with the receiving arms of a hook/unhookdevice positioned in close proximity to the crescent and to a segment oftissue being sutured, for manipulating the suturing thread.

FIG. 99 is a perspective view of a receiving arm illustrated in FIG. 98,more particularly illustrating engagement of the thread by the openthread access slot in the receiving arm.

FIG. 100 is a perspective view of a receiving arm, more particularlyillustrating severing of the thread by forward movement of thegrip/cut/eject blade through the access slot that holds the thread inplace, as illustrated in FIG. 99.

FIG. 101 is a perspective view of a receiving arm, illustratingretraction of the grip/cut/eject blade and preparatory blade slope intothe receiving arm and into the thread access slot to alternatively ejectthe thread from the slot, in lieu of cutting the thread as illustratedin FIG. 100.

FIG. 102 is a perspective view, partially in section, of one of thereceiving arms illustrated in FIG. 98, attached to a housing enclosing apair of plunger discs (illustrated in phantom) for manipulating thevarious elements of the receiving arm.

FIG. 102A is a perspective view of a receiving arm, illustratingalignment of the respective access slots.

FIG. 103 is a side sectional view of the receiving arm and operatingelements, more particularly illustrating the relationship between thegrip/eject/cut blade element and the inner housing tube elements, of thehook/unhook device.

FIG. 104 is a perspective view of the pair of receiving arms in thehook/unhook device, with the receiving arms located in close proximityto tissue being sutured and the suturing thread, for manipulating thethread into suturing knots.

FIG. 105 is a perspective view of the receiving arms of the hook/unhookdevice illustrated in FIG. 104, more particularly illustratingengagement of respective thread segments by the arms and furthermanipulating the thread segments to tie a knot in the suturing thread.

FIG. 106 is a perspective view of the receiving arms illustrated inFIGS. 104 and 105, more particularly illustrating additionalmanipulation of the receiving arms to tighten the knot in the threadduring the suturing operation.

FIG. 107 is a perspective view of a preferred embodiment of the housingtube of the hook/unhook device, with a receiving arm extending from oneend of the housing tube in engagement with the length of the thread formanipulating the thread.

FIG. 108 is a perspective view, partially in section, of the housingtube illustrated in FIG. 107, more particularly illustrating theinternal components of the housing tube and the receiving armmanipulating elements attached to the housing tube for manipulating thereceiving arms.

FIG. 109 is a perspective view of a unidirectional device of the cyclingsuturing and knot-tying device.

FIG. 109A is an exploded view of a unidirectional device illustrated inFIG. 109, more particularly illustrating the fixed way/case, the driverblades and connection member mount and the crescent needle.

FIG. 109B is a perspective view of a preferred discontinuous-toothbeveled pinion gear for driving the unidirectional device illustrated inFIG. 109A.

FIG. 109C is a perspective view of the unidirectional device, with theneedle in place and ready for incrementation around the fixed way/case.

FIG. 109D is a perspective view of one end of the fixed way/case,illustrating an array of the fixed way blades.

FIG. 109E is a perspective view of the opposite end of the fixedway/case from the end illustrated in FIG. 109D, further illustrating anarray of the fixed way blades.

FIG. 109F is a perspective view of a reciprocal driver element,including the three, spaced-apart driver housing bosses mounted on theconnection member and fitted with driver blades and a beveled rack.

FIG. 109G is a bottom perspective view of the reciprocal driver,illustrated in FIG. 109F, more particularly illustrating the beveledrack.

FIG. 109H is a bottom perspective view of the reciprocal driver with thearcuate needle in place.

FIG. 109I is a bottom perspective view of the fixed way/case and thereciprocal driver with the beveled rack projecting through a slot in thefixed way/case.

FIG. 109J is a top perspective view of the fixed way/case with the fixedway blades in place engaging the needles.

FIG. 110 is a top perspective view of the fixed way/case connected to asocket for attachment to an operator.

FIG. 110A is a bottom perspective view of the reciprocal driverillustrated in FIG. 109G, fitted with drive cable extensions forreceiving drive cables.

FIG. 110B is a bottom perspective view of an alternative embodiment ofthe reciprocal driver further detailing a drive cable extension forreceiving a drive cable.

FIG. 110C is a top view of the reciprocal driver, more, particularlyillustrating the driver blades in the respective spaced-apart driverhousing bosses.

FIG. 111 is a top view of the unidirectional device fitted with thereciprocal driver, more particularly illustrating the proximity of thedevice to tissue material to be sutured and the positioning of theneedle in the device for suturing the tissue.

FIG. 111A is a top view of the unidirectional device 1 illustrated inFIG. 111, more particularly illustrating initial incrementation of theneedle around the device and entering the material to be sutured.

FIG. 111B is a top view of the unidirectional device illustrated inFIGS. 111 and 111A, illustrating further incrementation of the needlethrough the tissue to be sutured and entering the opposite end of thedevice.

FIG. 111C is a top view of the unidirectional device illustrated inFIGS. 111-111B, more particularly illustrating completion of the needlerotation through the material to be sutured.

FIG. 112 is a top view of one end of an alternate unidirectional device,more particularly illustrating an alternate driver inserted in analternate fixed way.

FIG. 112A is a top view of the opposite end of the alternateunidirectional device illustrated in FIG. 112, further illustrating thealternate driver fitted in the alternate fixed way.

FIG. 112B is a top view of another embodiment of the alternateunidirectional device, wherein a second alternate driver is fitted inthe alternate fixed way.

FIG. 112C is a top view of the opposite end of the alternateunidirectional device illustrated in FIG. 112B, with the secondalternate driver in the alternate fixed way.

FIG. 112D is a perspective view, partially in section, of alternatefixed way blades, each fitted with a serrated needle contact area.

FIG. 113 is a rear perspective view of a forked blade device embodimentof the cycling suturing and knot-tying device, in assembledconfiguration for attachment to a suitable operator.

FIG. 114 is a bottom perspective view of the forked blade deviceillustrated in FIG. 113.

FIG. 115 is a perspective view of the bottom-slotted case element of theforked blade device illustrated in FIGS. 113 and 114.

FIG. 116 is a bottom view of the slotted case illustrated in FIG. 115,more particularly illustrating the bottom slots.

FIG. 117 is a perspective view of the driver element of the forked bladedevice illustrated in FIG. 113.

FIG. 117A is a bottom perspective view of the driver element illustratedin FIG. 116, more particularly illustrating a preferred attachment ofdrive cables to the driver.

FIG. 118 is a perspective view of the housing element of the forkedblade device illustrated in FIG. 113.

FIG. 118A is a bottom perspective view of the housing elementillustrated in FIG. 118, more particularly illustratingdownwardly-extending tab extensions and weld attachment grooves forattaching operating cables to the housing.

FIG. 119 is a perspective view of the case and housing elements of theforked blade device in assembled configuration.

FIG. 120 is a perspective view of the three forked blade assembliesspaced-apart to receive the crescent-shaped needle for driving theneedle in either the counterclockwise or clockwise direction in theforked blade device illustrated in FIG. 113.

FIG. 121 is a perspective view of the case element with the pivotingforked blades installed therein and with the driver and housingelement(s) seated in the case.

FIG. 122 is a bottom perspective view of the driver and housing infunctional configuration with the forked blades in position forincrementing the needle in the forked blade device.

FIG. 123 is a perspective view of the fixed way element of the forkedblade device illustrated in 113.

FIG. 124 is a bottom perspective view of the fixed way elementillustrated in FIG. 123, with the arcuate needle positioned infunctional configuration therein.

FIG. 125 is a top perspective view of the assembled forked blade deviceillustrated in FIG. 113, with the way covers removed for brevity, moreparticularly illustrating the driver housing forked blades and fixed wayinstalled in the case.

FIG. 126 is an enlarged perspective view of a typical forked bladeassembly having a forked blade in close proximity to the arcuate needle,wherein the forked blade assembly is in neutral configuration withrespect to the needle.

FIG. 126A is a perspective view of the forked blade assembly illustratedin FIG. 126, wherein the forked blade is rotated or pivoted in theclockwise direction to engage the needle for counterclockwise needleincrementation in the forked blade device.

FIG. 127 is a top view of the assembled forked blade device, moreparticularly illustrating a forked blade needle-engaging configurationto effect counterclockwise rotation of the needle in the forked bladedevice.

FIG. 128 is a top view of the forked blade device illustrated in FIG.127, more particularly illustrating a forked blade needle-engagingconfiguration facilitating clockwise rotation of the needle in theforked blade device.

FIG. 128A is a top view of the forked blade device illustrated in FIGS.127 and 128, more particularly illustrating incrementation of the needlein the clockwise direction by operation of a suitable operatorresponsive to locking of the forked blades in a counterclockwiseconfiguration.

FIG. 129 is a top view of the forked blade device placed in closeproximity to a material to be sutured, more particularly illustratingpositioning of the forked blades against the needle to effectcounterclockwise rotation of the needle in the forked blade device.

FIG. 130 is a top view of the forked blade device illustrated in FIG.129, more particularly illustrating incrementation of the needle intothe material to be sutured responsive to incrementation of the housingand driver elements of the forked blade device.

FIG. 131 is a top view of the forked blade device illustrated in FIGS.129 and 130 and more particularly illustrating further incrementation ofthe needle through the material to be sutured with the thread carriedthrough the suturing opening, responsive to further incrementation ofthe driver and housing elements of the forked blade device.

FIG. 132 is a top view of the forked blade device illustrated in FIGS.129-131, more particularly illustrating the follow-through of the needleas further incremented through the material to be sutured and the threadcarried through the needle suture opening, responsive to additionalincrementation of the driver and housing elements of the forked bladedevice.

FIG. 133 is a top view of the forked blade device illustrated in FIGS.129-132, more particularly illustrating still further incrementation ofthe needle responsive to incrementation of the driver and the housing inthe forked blade device.

FIG. 134 is a perspective view of an alternative forked blade design forreceiving the needle, with the forked blades in neutral configuration.

FIG. 135 is an enlarged view of one of the forked blades in thealternative forked blade design illustrated in FIG. 134, moreparticularly illustrating rotation or pivoting of the forked blade inthe clockwise direction to engage the needle in driving configurationand driving the needle in the counterclockwise direction around theforked blade device.

FIG. 136 is a perspective view of another design for the forked bladesin the forked blade device.

FIG. 137 is a top view of the alternative design of the forked bladesillustrated in FIG. 136.

FIG. 138 is a top view of one of the alternative forked bladesillustrated in FIGS. 136 and 137, more particularly illustratingengagement of the alternative forked blades with a needle to drive theneedle in the forked blade device.

FIG. 139 is a perspective view of a tubular forked blade device of thecycling suturing and knot-tying device in assembled configuration andready for incrementation of the needle for suturing.

FIG. 140 is an exploded view of the tubular forked blade deviceillustrated in FIG. 139.

FIG. 141 is a perspective view of the tubular forked blade deviceillustrated in FIG. 139 with the needle-engaging blades removed forbrevity.

FIG. 142 is a perspective view of a spring pressure pad assembly for usein the tubular forked blade device illustrated in FIG. 139.

FIG. 143 is a perspective view of the spring pad assembly illustrated inFIG. 142 with the arcuate needle in functional configuration on therespective mounting springs.

FIG. 144 is an enlarged perspective view of a fixed segment element ofthe lower fixed support frame tubular member, with one of the springpressure pad assemblies in place, more particularly illustratingengagement of a retaining pad with the needle.

FIG. 145 is an exploded view of a blade housing and blade, moreparticularly illustrating a first preferred mounting of the blade in theblade housing.

FIG. 146 is a perspective view of the blade housing and bladeillustrated in FIG. 145 in assembled configuration, more particularlyillustrating the pivoting function of the blade in the blade housing.

FIG. 147 is a sectional view of an alternative preferred blade and bladehousing design.

FIG. 148 is a top view of the tubular forked blade device illustrated inFIG. 145, more particularly illustrating typical incrementation of theneedle through material to be sutured responsive to incrementation ofthe middle tube assembly and the drive spur in cooperation withengagement of the blades on the needle.

FIG. 149 is a top view of the tubular forked blade device illustrated inFIG. 148, more particularly illustrating opposite incrementation of theneedle in the counterclockwise direction responsive to correspondingmovement of the middle tube assembly and the drive spur.

FIG. 150 is a top view of a typical configuration for attaching threadto the center of the arcuate needle illustrated in FIG. 139.

FIG. 151 is a sectional view taken along line 151-151 in FIG. 150, moreparticularly illustrating a preferred connection between the thread andthe needle.

FIG. 152 is a sectional view taken along line 152-152 in FIG. 150, moreparticularly illustrating the preferred thread-needle attachment.

FIG. 153 is a longitudinal sectional view of the tubular forked bladedevice illustrated in FIG. 139, more particularly illustrating a typicaldriver or operator attached to the tubular forked blade device foreffecting incrementation of the middle tube assembly and the drive spur,to increment the needle in the tubular forked blade device.

FIG. 154 is a side view, partially in section, of the tubular forkedblade device, more particularly illustrating a flexible tube connectionto the tubular forked blade device for articulation of the forked bladedevice into a desired configuration in a suturing operation.

FIG. 155 is a sectional view of the main tubular extension attached tothe tubular forked blade device for articulating the tubular forkedblade device responsive to operation of a cable arrangement extendingthrough the respective tubular extensions.

FIG. 156 is a sectional view of an extension structure and drive systemfor incrementing the drive spur and driving the middle tube assembly toeffect incrementation of the needle in the tubular forked blade device.

FIG. 157 is a sectional view of the extension structure illustrated inFIG. 156, more particularly illustrating a direction-changing leverelement for incrementing the drive spur prior to driving the middle tubeassembly and the drive spur in concert and incrementing the needle inthe tubular forked blade device.

FIG. 158 is a sectional view of the extension structure illustrated inFIG. 157, more particularly illustrating a typical drive motor and drivegear arrangement for driving the middle tube assembly and the drive spurto increment the needle in the tubular forked blade device.

FIG. 159 is a perspective view of the planetary wheel/gear deviceembodiment of the cycling suturing and knot-tying device, moreparticularly illustrating a preferred articulating mechanism forpositioning the disc body in a variety of positions with respect to amaterial to be sutured.

FIG. 160 is a bottom perspective view of the planetary wheel/gear deviceillustrated in FIG. 159.

FIG. 161 is a longitudinal sectional view of the planetary wheel/geardevice illustrated in FIGS. 159 and 160.

FIG. 162 is an exploded view of the planetary wheel/gear device, moreparticularly illustrating the conical central gear and toothed rotordriving system.

FIG. 163 is a top view of the planetary wheel/gear device, moreparticularly illustrating directions of rotation of the conical centralgear and the respective toothed rotors to effect a counterclockwiseincrementation of the needle in the planetary wheel/gear device.

FIG. 164 is a top view of the planetary wheel device illustrated in FIG.163, more particularly illustrating incrementation of the needle throughmaterial to be sutured by operation of the needle drive system,including the conical central gear and the toothed rotors.

FIG. 165 is a sectional view of an alternative preferred embodiment ofthe conical central gear and concave rotors for incrementing the needlearound the planetary wheel/gear device.

FIG. 166 is a sectional view of yet another alternative design for theconical central gear and alternate tooth rotors for incrementing theneedle around the planetary wheel/gear device.

FIG. 167 is a perspective view of a flexible rotor device embodiment ofthe cycling suturing and knot-tying device, including an arcuate discand a flexible rotor mounted in the disc for incrementing the needleinside the disc in a suturing operation.

FIG. 168 is a perspective view of the disc element of the flexible rotordevice illustrated in FIG. 167.

FIG. 169 is a perspective view of the flexible rotor element of theflexible rotor device.

FIG. 170 is an exploded view of the disc element and a protective platefor enclosing the flexible rotor in the disc of the flexible rotordevice.

FIG. 170A is a perspective view of the disc element of the flexiblerotor device with the arcuate needle in functional configuration in thedisc.

FIG. 170B is a perspective view of the disc and needle illustrated inFIG. 170A, with the flexible rotor installed inside the disc forrotating the flexible rotor in the disc and incrementing the needleresponsive to operation of a suitable drive system.

FIG. 171 is a perspective view of the flexible rotor element of theflexible rotor device, more particularly illustrating counterclockwiserotation of the flexible rotor.

FIG. 172 is a perspective view of the flexible rotor element illustratedin FIG. 171, disposed for clockwise rotation in the flexible rotordevice.

FIG. 173 is a sectional view of the disc and flexible rotor, moreparticularly illustrating engagement of the needle by the flexiblerotor.

FIG. 174 is a sectional view of the disc and flexible rotor, moreparticularly illustrating non-engagement of a flexible rotor with aneedle and illustrating a typical drive train for rotating the flexiblerotor within the disc.

FIG. 175 is a side elevation, partially in section, of an alternativedrive system for driving the flexible rotor in the disc and incrementingthe needle for suturing.

FIG. 176 is a bottom perspective view of another alternative directdrive system for rotating the flexible rotor inside the disc andoperating the flexible rotor device.

FIG. 177 is a perspective view of a pawl and crank device embodiment ofthe cycling suturing and knot-tying device, with the pawl and crankdevice illustrated in articulated attachment to a typical operator.

FIG. 177A is a perspective view of the pawl and crank device, moreparticularly illustrating a disc cover on the disc, with the needle infunctional configuration for suturing.

FIG. 177B is a perspective view of a typical pawl with a V-shaped camslot and crank installed therein for engaging the needle by the pawlteeth and incrementing the needle in the disc illustrated in FIG. 177A.

FIG. 177C is a perspective view of the disc element with the crankextending therein.

FIG. 177D is a perspective view of the disc illustrated in FIG. 177C,more particularly illustrating an opening for receiving the crankillustrated in FIG. 177C.

FIG. 178 is a perspective view of the assembled pawl and crank locatedin the disc, more particularly illustrating the grooved way in the discfor receiving a needle to facilitate incrementing the needle around theway by incrementation of the pawl by rotation of the crank.

FIG. 179 is a perspective view of the pawl and crank device illustratedin FIG. 178 illustrating rotation of the crank to force the pawl in aclockwise direction disengaged from the needle.

FIG. 180 is a perspective view of the pawl and crank device illustratedin FIGS. 178 and 179, more particularly illustrating further rotation ofthe crank to effect continued movement of the pawl in the clockwiseconfiguration, disengaged from the needle.

FIG. 181 is a perspective view of the pawl and crank device illustratedin FIGS. 178-180, more particularly illustrating further rotation of thecrank for driving the pawl in the opposite or counterclockwise directionaround the disc and upwardly against the needle.

FIG. 182 is a perspective view of the pawl and crank device illustratedin FIGS. 178-181, more particularly illustrating further rotation of thecrank for driving the pawl and the needle in the counterclockwisedirection.

FIG. 183 is a perspective view of the pawl and crank device illustratedin FIGS. 178-182, more particularly illustrating a neutral position ofthe crank to facilitate terminating movement of the pawl and stoppingmovement of the needle in the disc.

FIG. 184 is a perspective view of the pawl and crank device illustratedin FIG. 183, more particularly illustrating rotation of the crank in theopposite direction to drive the pawl in the clockwise direction andupwardly against the needle, for incrementing the needle in theclockwise direction.

FIG. 185 is a perspective view of the pawl and crank device illustratedin FIGS. 183 and 184, more particularly illustrating additionalclockwise rotation of the crank to drive the pawl and needle further inthe clockwise direction around the disc.

FIG. 186 is a perspective view of the pawl and crank device illustratedin FIGS. 183-185, more particularly illustrating additional clockwisecrank rotation to rotate the pawl in the counterclockwise direction awayfrom the needle.

FIG. 187 is a perspective view of the pawl and crank device illustratedin FIGS. 183-186, more particularly illustrating further clockwise crankrotation to drive the pawl further in the counterclockwise direction andaway from the needle.

FIG. 188 is a perspective view of the pawl and crank device illustratedin FIGS. 183-187, more particularly illustrating additional clockwiserotation of the crank to effect operation of the pawl and needle in anew clockwise rotational sequence.

FIG. 189 is a generally perspective view of an alternate form of thesuturing device of the present invention.

FIG. 190 is a generally perspective view of the suturing device shown inFIG. 189 as viewed from one side of the device and broken away to showinternal construction.

FIG. 190A is a greatly enlarged, generally perspective, fragmentary viewof the area designated in FIG. 190 as 190A.

FIG. 190B is a generally perspective view, similar to FIG. 190, butshowing the trigger in an actuated position.

FIG. 190C is a greatly enlarged, generally perspective, fragmentary viewof the area designated in FIG. 190B as 190C.

FIG. 191 is a generally perspective view of the suturing device shown inFIG. 189 as viewed from the opposite one side of the device and brokenaway to show internal construction.

FIG. 191A is a greatly enlarged, generally perspective, fragmentary viewof the area designated in FIG. 191 as 191A.

FIG. 192 is a view similar to FIG. 191, but showing the trigger in anactuated position.

FIG. 192A is a greatly enlarged, generally perspective, fragmentary viewof the area designated in FIG. 192 as 191C.

FIG. 193 is a greatly enlarged, generally perspective, fragmentary viewof the articuatable head portion of the device and of the couplingsubassembly for coupling the head portion to the barrel portion of thedevice.

FIG. 194 is a top plan view of the articulatable head portion of thedevice as it appears after the cover portions have been removed toreveal the internal construction thereof.

FIG. 195 is a top plan view similar to FIG. 194, but showing thelocation of the suturing needle of the device after it has been movedfrom the position illustrated in FIG. 194 to a first advanced position.

FIG. 196 is a generally perspective, top view similar to FIG. 195further showing the location of the suturing needle of the device afterit has been advanced in a clockwise direction.

FIG. 197 is a generally perspective, exploded view showing more clearlythe various operating components of the head portion of the suturingdevice.

FIG. 198 is a greatly enlarged, generally perspective view of one formof the suturing needle of this latest form of the suturing device.

FIG. 199 is a greatly enlarged, generally perspective view of one of theneedle engaging members of the invention that, during operation of thedevice, function to control movement of the suturing needle within asuturing needle guide way formed in the body of the head portion of thedevice.

FIG. 200 is a greatly enlarged diagrammatic view of the needle engagingmembers of the invention illustrating their interaction with the needleduring advancement of the shuttle member.

FIG. 201 is a greatly enlarged diagrammatic view of the needle engagingmembers of the invention illustrating their interaction with the needleduring retraction of the shuttle member.

FIG. 202 is a generally enlarged diagrammatic view of the head portionof the apparatus broken away to illustrate the cooperative interactionof the operating cables of the apparatus on the shuttle member.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring initially to FIGS. 1-5 of the drawings one embodiment of thecycling suturing and knot-tying device of this invention is generallyillustrated by reference numeral 1. A transmission tube 1200 ischaracterized by a generally cylindrically-shaped, elongated, hollowtube having a selection bearing socket 1253 on one end, with a lever1251 pivotally extending therefrom, the transmission tube 1200 taperinginwardly at the opposite end to define a transition cone 1245. Anelongated extension tube 1240 projects from the small end of thetransition cone 1245 and terminates at a transition guide cone 1238(FIG. 5), which receives and mounts an arcuate crescent 101, asillustrated. In a preferred embodiment of the invention the transmissiontube 1200 is mounted for articulation on a cradle 1276A, seated in ahousing 1265. A handle 1260 is attached to the housing 1265 and isfitted with a trigger 1267 for driving a curved suturing needle 50(illustrated in FIG. 5) in the crescent 101, as hereinafter furtherdescribed. Intermediate the selection bearing socket 1253 and thetransition cone 1245 is provided a drive input section 1200C (FIG. 3)that includes a reciprocation input collar 1216, for interacting withthe trigger 1267 and driving the needle 50 in the crescent 101. Adirection setting switch section 1200D, including a slide switch mountbody 1211, is also provided on the extension tube 1200 forwardly of thereciprocation input collar 1216 and is fitted with a pair of pressureopposing rings 1211A and a direction actuator 1214, slidably positionedon the transmission tube 1200 between the pressure opposing rings 1211A,for changing the direction of rotation of the needle 50 in the crescent101, as further hereinafter described.

Referring now to FIG. 2 of the drawings it will be appreciated that thetransmission tube 1200 and housing 1265 can be articulated to the leftor right with respect to the handle 1260 to precisely position thecrescent 101 in a desired location with respect to tissue to be sutured.Accordingly, the extension tube 1240 and crescent 101 on the extendingend of the transmission tube 1200 can be articulated to any selectedangle from the far left position illustrated in FIG. 2, to a far rightposition (not illustrated), for the purpose. Similarly, the extensiontube 1200 can be pitched downwardly and upwardly throughout a wide angleof pitch by pivoting the cradle 1276A on the handle 1265 and theextension tube 1200 can be rotated 306-degrees along its longitudinalaxis within the cradle 1276A, thus further facilitating precisepositioning of the crescent 101 in a desired position in close quartersduring a suturing operation.

As further illustrated in FIG. 4 of the drawings a second handle 1261,having a second handle trigger 1261B, can be attached to the handle 1260by means of a flexible connection 1261A and a flexible tube 1141 isprojected from the second handle 1261 to a thread incrementing accessory(not illustrated) mounted on the crescent 101, for purposes which willbe hereinafter further described.

Referring again to FIG. 5 of the drawings in a preferred embodiment thecrescent 101 is attached to the tapered transition guide cone 1238 ofthe transmission tube 1200 by means of a fixed joint ball 780, providedon the extending end of the transition guide cone 1238. The joint ball780 is seated in the socket cavity 775C of a socket 775 provided in thecrescent 101 and this connection facilitates universal articulation ofthe crescent 101 with respect to the transition guide cone 1238.Controlled universal articulation of the crescent 101 on the joint ball780 is facilitated by four crescent angle articulation cables 1256A,1256B, 1256C and 1256D, respectively, typically extending from withinthe transition guide cone 1238, through corresponding cable holes 1238A,1238B, 1238C and 1238D, respectively. As further illustrated in FIG. 5,the extending end of each of the crescent articulation cables 1256A,1256B, 1256C and 1256D is attached by any suitable method tocorresponding base corners 776A, 776B, 776C and 776D, respectively, ofthe socket 775, while the opposite ends of these cables are attached tothe lever 1251, illustrated in FIGS. 1-4, as hereinafter described, suchthat manipulation of the lever 1251 applies tension in the correspondingone of the crescent angle articulation cables 1256A, 1256B, 1256C and1256D, to manipulate and articulate the crescent 101 into a desiredposition with respect to the tissue 100, illustrated in phantom in FIG.5. Accordingly, in a preferred embodiment of the invention the crescentangle articulation cables 1256A, 1256B, 1256C and 1256D extend from thelever 1251 connection assembly, through the transmission tube 1200, thetransition cone 1245, the extension tube 1240 and through thecorresponding transition guide cone cable inlet holes 1238A, 1238B,1238C and 1238D, respectively, in the transition guide cone 1238, to thesocket 775 on the crescent 101.

Referring now to FIGS. 1, 5, 6, 6A and 6B of the drawings in a preferredembodiment of the invention the crescent 101 illustrated in FIGS. 1-5 ischaracterized by a crescent-shaped case 102, which defines a continuouscurved groove, except for a gap 105 between the extending ends thereof,which case 102 is mounted on the socket 775 by any suitable means,typically including welding, bolting, bradding or the like, innon-exclusive particular. An arcuate fixed way direction setting plate136 is seated in the case 102 and is designed to receive a shorter,curved drive direction setting plate 134, the latter of which responds,by means of operating components hereinafter described, to manipulationof the slide switch mount body 1211 on the transmission tube 1200, fordetermining the direction of rotation of the arcuate needle 50, furtherillustrated in FIG. 6. The drive direction setting plate 134 is seatedon the fixed way direction setting plate 136 and receives acorrespondingly-shaped reciprocating driver 108, designed toincrementally drive the crescent-shaped needle 50 in a directiondetermined by the position of the driver direction setting plate 134, inrelation to the reciprocating driver 108. An arcuate fixed way 104 ispositioned on the reciprocating driver 108 for accommodating andstabilizing the arcuate needle 50, which is provided with a length ofthread 50 a, as further illustrated in FIG. 6.

Assembly of the respective components of the crescent 101 illustrated inFIG. 6 except the fixed way 104, is illustrated in FIGS. 6A and 6B,wherein a segment of the needle 50 is shown in position on the needledriver 108. The needle driver 108, drive direction setting plate 134 andthe fixed way direction setting plate 136 are all stacked and seated inthe though-like case 102 and maintained in place by any convenienttechnique, typically by attaching the fixed way housings 104A-104D tothe walls of case 102, e.g., welding or press-fit. As furtherillustrated in FIG. 6B of the drawings, one of a pair of directionsetting access side extensions 141 is illustrated and extends through acase clearance slot 143 in the case base 102A of the case 102 andthrough an aligned fixed way direction setting plate slot 142 in thefixed way direction setting plate 136, for mounting on the drivedirection setting plate 134 and attachment to a cable (not illustrated)that extends to the components of the slide switch 1211 for effecting achange in the direction of rotation of the needle 50 as it traverses thefixed way 104. Similarly, a pair of drive access cable extensions 140(one of which is illustrated in FIG. 6B) also extends from thespaced-apart blade group housings 110 and 110B in the reciprocatingdriver 108, through the case clearance slot 143 provided in the casebase 102A of the case 102 and through the aligned fixed way directionsetting plate slot 142 in the fixed way direction setting plate 136, andthe longer tab clearance slot 145A in the drive direction setting plate134. A second cable (not illustrated) extends from attachment to thedrive access cable extension 140 to the reciprocation input collar 1216on the transmission tube 1200 (FIGS. 1-5) and incrementally drives theneedle 50 in the fixed way 104 in a direction determined by operation ofthe drive direction setting plate 134 and the fixed way directionsetting plate 136, by operation of the trigger 1267 in the handle 1260(FIGS. 1-5) as hereinafter further described.

Referring now to FIGS. 6-13A of the drawings the arcuate reciprocatingdriver 108 is illustrated and is fitted with three, spaced-apart bladegroup housings, 110, 110A and 110B, mounted on a group housing base 111,fitted with a pair of curved, parallel driver longer tab clearance slots144 (FIGS. 8A and 8B). Two of the blade group housings, 110 and 110B,are positioned at the extreme ends of the crescent-shaped reciprocatingdriver 108 and the third blade group housing 110A is located in thecenter of the reciprocating driver 108, approximately equally spacedbetween the blade group housings 110 and 110B (FIGS. 6, 8A and 8B). Asfurther illustrated in FIG. 7, the curved needle 50 extends through agroove or track provided in the group housing base 111 of the bladegroup housing 110A (as well as in the blade group housings 110 and 110B,(not illustrated). Furthermore, two sets of oppositely-disposed, dualdirectional blade clearance slots 120 are provided in each group housingbase 111 facing the needle 50 in angular relationship, for receiving thedriver blades 112, respectively. The driver blades 112 are seated inblade mounting slots 122 provided in the base of the respective bladeclearance slots 120, in two sets of six, oppositely-disposed driverblades 112 and the respective sets or groups of driver blades 112 arepositioned in opposite directions and identified as forwardly-incliningdriver blades 112B and rearwardly-inclining driver blades 112C, inaccordance with the opposite directional positioning of the two sets ofblade clearance slots 120.

Referring to FIGS. 7-7B, each of the driver blades 112 typicallyincludes a vertical leaf tensioning tab 118 or a longer tab 118A(illustrated in phantom in FIG. 7A) connected to a vertical fin 116 bymeans of a narrow, bendable center spring leaf 114. Each of the leaftensioning tabs 118 is further characterized by a bottom rounded end119A that curves to define a concave needle contact profile 117, havingangle chisels 117A and 117B (FIG. 7B), which concave needle profile 117terminates in a top rounded end 119. Accordingly, as illustrated in FIG.7, one set of the driver blades 112 (the forwardly-inclining driverblades 112B) are oppositely-disposed and positioned with thecorresponding concave contact profiles 117 (FIG. 7A) positioned forengaging the needle 50 to drive the needle 50 in the counterclockwisedirection, while the corresponding second set of driver blades 112 (therearwardly-inclining driver blades 112C) are positioned in the oppositedirection to sequentially engage the needle 50 at the correspondingconcave contact profiles 117 when the needle 50 is to be driven in theopposite, or clockwise direction. As further illustrated in FIG. 7, theextreme ends of the blade group housings 110, 110A and 110B in thereciprocating driver 108 are each shaped to define oppositely-disposedangle entry guides 127, to facilitate sure entry of the beveled ends ofthe needle 50 as the needle 50 incrementally moves in the crescent 101by operation of the reciprocating driver 108.

Referring again to FIGS. 6-10 of the drawings the drive directionsetting plate 134 is positioned beneath and adjacent the reciprocatingdriver 108 as illustrated in FIGS. 6, 6B, 9 and 10. The drive directionsetting plate 134 is fitted with three, spaced-apart groups of two setseach, of oppositely-disposed, dual-directional fixed way directionsetting plate parallelogram holes 138 that receive the elongated,downwardly-extending leaf tensioning tab 118 of each of thecorrespondingly positioned driver blades 112, as illustrated in FIG. 8.The top portions of each of the respective driver blades 112 are seatedin the respective driver blade clearance slots 120 in the reciprocatingdriver 108, as illustrated in FIG. 7 and as heretofore discussed. It issignificant that each of the drive direction setting plate parallelogramholes 138 are shaped in the configuration of a parallelogram, the angledwalls 139 of which parallelograms are essentially parallel to therespective leaf tensioning tabs 118, and are disposed for contacting theleaf tensioning tabs 118 in sequence responsive to rotation of the drivedirection setting plate 134, for purposes described below.

As illustrated in FIGS. 8A, 8B and 10 of the drawings and beginning withFIG. 8A, the blade group housing 110B segment of the reciprocatingdriver 108 is illustrated superimposed on the corresponding section ofthe drive direction setting plate 134 of the crescent 101. The forwardset of oppositely-disposed driver blades 112 (the forwardly-incliningdriver blades 112B) engage the curved needle 50 as they are slightlybent at each narrowed center leaf spring leaf 114, respectively, byrearward setting position of the underlying drive direction settingplate 134. Accordingly, the forwardly-inclining driver blades 112B arein needle-driving configuration, such that operation of thereciprocating driver 108 in the counterclockwise direction of theforward arrow 110C advances the needle 50 in that direction responsiveto operation of the trigger 1267 in the cycling suturing and knot-tyingdevice 1 illustrated in FIG. 1. The rearward arrow 134B illustrates thedirection of setting movement of the drive direction setting plate 134,which rearward movement is required to bend and set theforwardly-inclining driver blades 112B for forward incrementation of theneedle 50. This bending of the respective forwardly-inclining driverblades 112B is effected by contact between the angled parallelogramsides 139 of the respective parallelogram holes 138 (FIG. 10) in thedrive direction setting plate 134 and the downwardly-extending leaftensioning tabs 118. The rearwardly-inclining driver blades 1112C areout of contact with the needle 50 during this counterclockwise directionof needle movement, as they are not engaged by the parallelogram sides139 of the parallelogram holes 138 in the drive direction setting plate134.

Referring now to FIG. 8B of the drawings, which shows the opposite endof the driver 108 and direction setting plate 134 and blade grouphousing 110, illustrated is the opposite mode of needle operation fromthat illustrated in FIG. 8A. Illustrated are the rearwardly-incliningdriver blades 112C set in needle-engaging configuration by forwardpositioning of the drive direction setting plate 134 as shown by thedirection of the forward arrow 134A. The parallelogram sides 139 of thecorresponding parallelogram holes 138 (FIG. 10) act upon the respectiveleaf tensioning tabs 118 of the rearwardly-inclining driver blades 112C,bending them into contact with the needle 50 and thus facilitatingrotation of the needle 50 in the opposite, or clockwise direction fromthat illustrated in FIG. 8A. The rearward clockwise arrow 110D,indicates the operation of the reciprocating driver 108 in thisdirection.

As illustrated in FIGS. 9 and 10 of the drawings the group housing base111 of the reciprocating driver 108 is fitted with twodownwardly-extending drive access cable extensions 140 (oneillustrated), which include a drive cable crimp trough 147 for receivinga cable (not illustrated) that connects to the reciprocating inputcollar 1216 mechanism on the transmission tube 1200 to facilitateoperation of the reciprocating driver 108 in a specific direction bymanipulation of the trigger 1267 on the handle 1260, as illustrated inFIG. 1 and as further hereinafter described. Further illustrated in FIG.9 are the downwardly-extending leaf tensioning tabs 118 of therespective sets of driver blades 112 which project through thecorresponding rectangular drive tab clearance holes 124, for projectioninto the corresponding drive direction setting plate parallelogram holes138 in the drive direction setting plate 134, as illustrated in FIG. 10and as heretofore described.

Referring to FIGS. 1, 10, 11 and 11A of the drawings the reciprocatingdriver 108 is shown assembled with the drive direction setting plate 134and the drive access cable extension 140, fixed to the group housingbase 111 of the reciprocating driver 108, is illustrated extendingthrough a longer tab clearance slot 145A in the drive direction settingplate 134, to facilitate driving of the needle 50 by operation of thereciprocating driver 108, with the drive direction setting plate 134 ina selected position with respect to the reciprocating driver 108 andtraveling with the reciprocating driver 108. Also illustrated in FIG. 10is the direction access cable extension 141 projecting downwardly fromfixed attachment to the drive direction setting plate 134. The directionsetting access cable extension 141 includes a direction cable crimptrough 148 for attachment to a cable (not illustrated) which is extendedthrough the transmission tube 1200 to the slide switch 1211 illustratedin FIG. 1. This connection facilitates changing the direction ofrotation of the needle 50 in the crescent 101 by manipulation of thedrive direction setting plate 134 with respect to the reciprocatingdriver 108 using the slide switch 1211, as heretofore described andhereinafter detailed. Further described in FIG. 10 are the respectiveparallelogram holes 138 in the drive direction setting plate 134, eachof which parallelogram holes 138 may have an angled parallelogram sideangle 139 for engaging the respective parallel leaf tensioning tabs 118of the driver blades 112 and bending the driver blades 112 at eachrespective center spring leaf 114, to effect selective engagement of theopposing sets of driver blades 112 with the needle 50, as illustrated inFIGS. 8A and 8B and as heretofore described.

As illustrated in FIG. 13A of the drawings the reciprocating driver 108is again shown assembled on the drive direction setting plate 134 andthe longer fixed way 104 is included in the assembly, the combinationmore particularly illustrating the capacity for bidirectional movementof the former with respect to the latter, and also illustrating downwardextension of one set of the respective pairs of drive access cableextension 140 and direction access cable extension 141, for operation ofthe reciprocating driver 108 and the drive direction setting plate 134beneath the fixed way 104, respectively.

Referring to FIGS. 12-13A of the drawings the reciprocating driver 108is illustrated assembled on the underlying drive direction setting plate134 in FIG. 13, such that one of the downwardly-extending drive accesscable extensions 140, attached to the group housing base 111 of thereciprocating driver 108 at the blade group housing 110, is illustratedextending through the corresponding slot inlet 149 in the drivedirection setting plate 134, that leads to the longer tab clearance slot145A, illustrated in FIG. 13. One end of a drive cable 1247 is tightlycrimped in the drive cable crimp trough 147 of the drive cable extension140. Further illustrated is one of the downwardly-extending directionaccess cable extensions 141, fixed to the drive direction setting plate134 and receiving one end of a direction cable 1248, which is tightlycrimped in the direction cable crimp trough 148 of the direction accesscable extension 141. The drive cable 1247 and the direction cable 1248are connected at the opposite ends to the reciprocating input collar1216 (and the trigger 1267) and to the slide switch 1211, respectively,both illustrated in FIG. 1, as heretofore described.

Referring now to FIGS. 13A, 14 and 15 of the drawings the reciprocatingdriver 108 and the drive direction setting plate 134 are illustrated asassembled and placed in assembled position beneath the fixed way 104, toillustrate the top assembly elements of the crescent 101. Furthermore,in FIG. 14 the fixed way direction setting plate 136 is added to theassembly of the drive direction setting plate 134, reciprocating driver108 and fixed way 104. Moreover, in FIG. 15 of the drawings the case 102is added to the assembly and one of the two drive access cableextensions 140, attached to the reciprocating driver 108 and one of thetwo direction access cable extensions 141, connected to the drivedirection setting plate 134, project downwardly through a case clearanceslot 142 in the case 102, with the drive cable 1247 and direction cable1248 shown as crimped in place, respectively. The fixed way 104, onceplaced over the other internal parts, fixed way direction plate 136,drive direction plate 134 and driver 108, can typically be spot weldedor otherwise attached to the case 102 for maintaining the assembledcomponents in place.

Referring to FIGS. 6, 16 and 17 of the drawings the fixed way 104 isillustrated and includes overhead connecting members 150 and 150A,separated by a curved needle access slot 150B, with the fixed wayhousings 104A, 104B, 104C and 104D provided in spaced-apart relationshipon the underside of the overhead connecting members 150 and 150A. Eachof the fixed way housings 104A, 104B, 104C and 104D includes two sets ofoppositely oriented, parallelogram-shaped fixed way blade mounting slots122A, for receiving corresponding longer tabbed fixed way blades 112A,as hereinafter further described. As further illustrated in FIG. 6 thefixed way 104 is mounted in any desired manner, directly above thereciprocating driver 108 but not so tightly as to prevent the driver 108from reciprocating. In this position the fixed way 104 receives thearcuate needle 50 in the needle access slot 150B, provided in the top ofthe fixed way 104 between the overhead connecting members 150 and 150A,for seating the needle 50 and accommodating the thread 50A withoutentangling the thread 50A as the needle 50 is incrementally drivenaround the fixed way 104 by operation of the reciprocating driver 108,as further hereinafter described.

As illustrated in FIGS. 6, 16, 18, 18A and 19 of the drawings the fixedway direction setting plate 136 is illustrated and is provided withoppositely-angled sets of fixed way direction setting plateparallelogram holes 138A, positioned in spaced-apart relationship aroundthe curvature of the crescent-shaped fixed way direction setting plate136 and vertically matching the fixed way blade clearance holes 124A inthe fixed way 104. The sets of fixed way direction setting plateparallelogram holes 138A that are mounted on the extending ends of thefixed way direction setting plate 136 are terminated at the inside endsby upward-standing bosses 136A and 136B, respectively. Furthermore,detent notches 137, detents 137A and 137B, clearance recesses 137E and137F and entrance stops 137C and 137D are shaped in the outside edges ofeach end segment of the fixed way direction setting plate 136 adjacentto the fixed way direction setting plate parallelogram holes 138A,respectively, as illustrated. These elements are instrumental incooperating with the drive direction setting plate 134 and determiningthe direction of advancement of the needle 50 in the fixed way 104, asfurther hereinafter described. The fixed way direction setting plate 136is also provided with a coplanar, curved, discontinuous fixed waydirection setting plate slot 142 that extends between respective sets ofthe fixed way direction setting plate parallelogram holes 138A toaccommodate the respective drive access cable extensions 140, extendingfrom the overlying reciprocating driver 108 and the direction accesscable extensions 141, projecting from the overlying drive directionsetting plate 134, as further illustrated in FIG. 6B.

Referring now to FIGS. 6, 18, 18A, 19, 20, 21 and 38 of the drawings thedrive direction setting plate 134 and the fixed way direction settingplate 136 are illustrated superimposed on the case 102, with thereciprocating driver 108 and the fixed way 104 omitted (FIGS. 20 and 21)to more particularly illustrate cooperation between the drive directionsetting plate 134 and the fixed way direction setting plate 136 indetermining the direction of needle rotation. FIG. 20 details the rangestop 137H and the clearance recess 137F that extends from the range stop137H, both located in a detent notch 137 (FIG. 19A) located on anoutside extending edge of one end (typically the receiving arm 101B) ofthe fixed way direction setting plate 136, with the fixed way housing104D of the fixed way 104 seated on the fixed way direction settingplate 136. A second range stop 137G and corresponding clearance recess137E (FIG. 19) are provided in a corresponding detent notch 137 locatedon the opposite extending end (typically advancing arm 101A) of thefixed way direction setting plate 136 (FIG. 39). The boss 136B is alsoillustrated in upward-standing configuration on the end of the fixed waydirection setting plate 136 illustrated in FIG. 19 and serves tointerrupt travel of the fixed way direction setting plate 136 withrespect to the fixed way 104, by contact with the fixed way housing 104D(FIG. 19), as hereinafter further described. Furthermore, the two setsof oppositely-oriented fixed way direction setting plate parallelogramholes 138A are also shown in the fixed way direction setting plate 136,along with an entrance stop 137D and corresponding detent 137B, bothlocated at the opposite end of the clearance recess 137F (located in thedetent notch 137) from the range stop 137H. As described abovecorresponding elements, including a second entrance stop 137C and detent137A, as well as a boss 136A, are provided on the opposite end of thefixed way direction setting plate 136 and some of these elements areillustrated in FIG. 39.

Referring again to FIGS. 1, 8A, 8B, 19, 20, 21 and 30-39 of thedrawings, shifting of the drive direction setting plate 134 and thefixed way direction setting plate 136 with respect to the fixed way 104(not illustrated in FIGS. 20 and 21) to set or determine the directionof traverse of the needle 50 in the fixed way 104, is illustrated. Asillustrated in FIGS. 8B, 20, 30-33, 38 and 39, when it is desired todrive the needle 50 in the clockwise direction on the fixed way 104(illustrated in sequence in FIGS. 30-33) by operation of thereciprocating driver 108 in a suturing operation, the drive directionsetting plate 134 is first shifted to contact the boss 136A of the fixedway direction setting plate 136 (FIGS. 32, 33 and 38) by operation ofthe slide switch mount body 1211 (FIG. 1). This action moves the fixedway direction setting plate 136 in the direction of the arrow 134A inFIG. 8B and the arrows illustrated in FIGS. 20 and 38, and bends therearwardly-inclining driver blades 112C in each of the blade grouphousings 110, 110A and 110B of the needle driver 108 into contact withthe needle 50 (FIG. 8B) to align the detent 137C and the fixed case boss102C, located on the lower portion of the outer wall of the underlyingcase 102 (FIG. 38). As further illustrated in FIG. 38 the fixed caseboss 102C rides in the moving clearance recess 137E between the rangestop 137G and the detent 137A. Accordingly, the drive direction settingplate 134 is shifted in the direction of the top arrow in FIG. 21, andas indicated by the bottom arrow 134A in FIG. 8B, is moved with respectto the underlying case 102 (FIG. 21), until the case boss 102C(illustrated in FIGS. 38-39 rides over the entrance stop 137C and seatsin the detent 137A (FIG. 39) in the fixed way direction setting plate136. The device is now set for incrementing the needle 50 in theclockwise direction, as hereinafter described.

Referring now to FIGS. 8A, 21 and 34-37 of the drawings shifting of thedrive direction setting plate 134 in the clockwise direction asindicated by the top arrow in FIG. 21 moves the fixed way directionsetting plate 136 in the clockwise direction, as the forwardly incliningdriver blades 112B in each of the blade group housing 110, 110A and 110Bof the needle driver 108 bend to contact the needle 50 (FIG. 8A) and thedrive direction setting plate 134 contacts the boss 136B and causes thecase boss 102D to engage the moving entrance stop 137D at the oppositeend of the clearance recess 137F from the range stop 137H and move overthe entrance stop 137D, to seat in the moving detent 137B (FIG. 21).This action terminates movement of the fixed way direction setting plate136 and facilitates driving of the needle 50 (not illustrated) in theopposite, or counterclockwise direction on the fixed way 104 byoperation of the reciprocating driver 108, as hereinafter described.

Referring again to FIGS. 22, 22A and 23 of the drawings the fixed waydirection setting plate 136, drive direction setting plate 134,reciprocating driver 108 and fixed way 104 are shown in assembledconfiguration, with the respective pairs of drive access cableextensions 140 and direction setting access cable extensions 141,respectively, illustrated in position extending through the fixed waydirection setting plate slot 142 in the fixed way direction settingplate 136 (FIGS. 22A and 23). FIG. 23 further illustrates the proximityof the longer tabs 118A of the longer tabbed fixed way blades 112A,secured in the fixed way housings 104A, 104B, 104C and 104D,respectively, in the same manner as the driver blades 112 in thereciprocating driver 108. The longer tabbed fixed way blades 112Aillustrated in FIG. 24 extend through the blade clearance slots 120 inthe fixed way housing 104A of the fixed way 104 and into-correspondingfixed way direction setting plate parallelogram holes 138A in the fixedway direction setting plate 136. The needle 50 is also shown in positionin the reciprocating driver, 108 and the fixed way 104, and the bladegroup housing 110 of the reciprocating driver 108 is illustrated inclose proximity to the fixed way housing 104A, with one end of the drivedirection setting plate 134 resting against the corresponding boss 136Aon the underlying fixed way direction setting plate 136. Accordingly, asfurther illustrated in bottom perspective in FIG. 24, the needle 50 isset for clockwise incrementation as viewed from the bottom. As contactbetween the drive direction plate 134 and the boss 136A has shifted thefixed way direction setting plate 136 in the opposite, orcounterclockwise direction, as described above. The longer tabbed fixedway blades 112A are bent as the corresponding longer tabs 118A arecontacted by the slanted or angled parallelogram sides 139 of therespective fixed way direction setting plate parallelogram holes 138Aand the blades engage the needle 50 to stabilize the needle 50 andprevent reverse incrementation of the needle 50 during operation of thedevice.

FIGS. 20, 21, 24-29 and 39 of the drawings illustrate an operationalsequence of the rotation of the needle 50 in the clockwise direction asseen from the bottom (FIGS. 24-29) responsive to operation of thereciprocating driver 108 superimposed on the drive direction settingplate 134, with the needle 50 placed in the reciprocating driver 108 andextending into the needle access slot 150B, defined by the overheadconnecting members 150 and 150A. The drive direction setting plate 134is initially positioned as illustrated in FIGS. 20 and 39, with theblade group housing 110 of the reciprocating driver 108 near thecorresponding fixed way housing 104A and the blade group housing 110B inthe reciprocating driver 108 spaced from the corresponding fixed wayhousing 104D in the fixed way 104 (FIG. 24). The drive direction settingplate 134 has previously been manipulated by operation of the twodirection setting access cable extensions 141 to the positionillustrated in FIGS. 20 and 39 to set the fixed way direction settingplate 136 as illustrated and facilitate rotation of the needle 50 in theclockwise direction responsive to incremented traversal of thereciprocating driver 108 and the drive direction setting plate 134 inconcert on the fixed way 104. When the blade group housing 110Bapproaches the fixed way housing 104D in the fixed way 104 asillustrated in FIG. 25, the needle 50, gripped by the reciprocatingdriver 108, is driven along the fixed way 104 to project outwardly ofthe fixed way housing 104D, as further illustrated in FIG. 25. At thepoint of—maximum traversal of the reciprocating driver 108 with respectto the fixed way 104, the needle 50 is released by reversal of thereciprocating driver 108 and held in place by the rearwardly-inclinedfixed way blades 112D in the fixed way 104. As the reciprocating driver108 is re-incremented in the counterclockwise direction, illustrated inFIG. 26, the needle 50 in the position illustrated in FIGS. 25 and 26 isreleased. The reciprocating driver 108 is thus returned to the positionillustrated in FIGS. 24 and 26 for another sequence of grasping androtating the needle 50 around the fixed way 104. Continued sequentialrotation of the needle 50 is effected by additional incremental forwardand backward traversal of the driver 108 on the fixed way 104 to theposition illustrated in FIGS. 27 and 28, such that the needle 50 isdriven progressively around the periphery of the fixed way 104 andthrough the gap 105 (FIG. 6) defined by the fixed way housings 104D and104A, respectively. Accordingly, when the reciprocating driver 108reaches the position illustrated in FIG. 27, the reciprocating driver108 again releases the needle 50 and reverses to the positionillustrated in FIG. 24, leaving the needle 50 in the advanced positionillustrated in FIG. 27. As the reciprocating driver 108 is caused tomake another sequential movement around the fixed way 104 as illustratedin FIG. 28, the needle 50 is driven completely across the gap 105between the fixed way housing 104D and the fixed way housing 104A, suchthat the trailing end of the needle 50 is illustrated in close proximityto the fixed way housing 104D. The reciprocating driver 108 is thenreturned again to the position illustrated in FIG. 24 and in FIG. 29after releasing the needle 50, for another gripping of the needle 50 anddriving the needle 50 sequentially around the fixed way 104 in theclockwise direction.

Under circumstances where it is desired to drive the needle 50 in thefixed way 104 in the opposite or counterclockwise direction, the drivedirection setting plate 134 is positioned as illustrated in FIGS. 21 and37 and as heretofore described, to set the fixed way direction settingplate 136 in the opposite position on the case 102 by contacting thedrive direction setting plate 134 with the boss 136B. This motion causesthe case boss 102D to engage the moving entrance stop 137D at theopposite end of the clearance recess 137F from the range stop 137H andmove over the entrance stop 137D to scat in the moving detent notch137B. The action terminates movement of the fixed way direction settingplate 136 in the direction of the arrow (FIG. 21). This reverses theoperational sequence described above in FIGS. 24-29 and facilitatesdriving of the needle 50 in the opposite, counterclockwise direction, asseen from below in the above sequence on the fixed way 104 in reversingthe operational sequence described above and illustrated in FIGS. 24-29of the drawings.

Referring now to FIGS. 1, 40 and 40A of the drawings the underside ofthe assembled crescent 101 is illustrated (FIG. 40) with the case 102fixed to the socket 775 and the joint ball 780 operatively connected tothe socket 775 to facilitate universal articulation of the crescent 101with respect to the joint ball 780 and the transmission tube 1200 byoperation of the crescent angle articulation cables 1256A, 1256B, 1256Cand 1256D, as illustrated in FIGS. 40 and 40A. As heretofore described,the crescent angle articulation cables 1256A, 1256B, 1256C and 1256Dextend from fixed attachment to the socket 775, through transition guidecone openings 1238A, 1238B, 1238C and 1238D, respectively, in thetransition guide cone 1238. From that point, the crescent anglearticulation cables 1256A, 1256B, 1256C and 1256D extend through theextension tube 1240 and through the transmission tube 1200 to theselection bearing socket 1253 and the lever 1251 (FIG. 1) as hereinafterfurther described. As further illustrated in FIGS. 40 and 40A, a threadincrementing accessory 1101 is provided on one end of the crescent 101for the purpose of manipulating and incrementing the thread 50A attachedto the needle 50 as the needle 50 traverses the crescent 101, as furtherhereinafter described.

Referring to FIGS. 1 and 41 of the drawings the interior of thetransmission tube 1200 is illustrated in FIG. 41 and includes a drivecable 1247, which extends throughout much of the length of thetransmission tube 1200 and a direction cable 1248 that parallels thedrive cable 1247 inside the transmission tube 1200. Further illustratedin FIG. 41 are the reciprocation input collar 1216, engaged by asprocket 1275, the direction actuator 1214 and a bottom insert 1205A anda companion top insert 1205B, that adjoin linearly to define essentiallya cylindrical member with linear surface slots for receiving the fourcrescent angle articulation cables 1256A, 1256B, 1256C and 1256D, thatterminate at one end at the selection bearing socket 1253, asillustrated. These four cables extend from the selection bearing socket1253, through the transmission tube 1200, and are directed to the centerof the extension tube 1240 at the transition cone 1245 and then throughthe extension tube 1240, to the transition guide cone 1238 and terminateat the crescent 101, as further hereinafter described.

Referring to FIGS. 42-52 of the drawings a detailed illustration of thehandle 1260, housing 1265 and cradle 1276A elements of the device, alongwith the trigger 1267 and the trigger mechanism for operating thevarious components in the crescent 101 (not illustrated) is illustrated.The housing 1265 is seated on a base 1265A (FIG. 47), which rests on aplatform area 1262, that terminates the top of the handle 1260 and acylindrical receptacle 1266 (FIG. 47) extends from the housing 1265 intoan opening provided in the platform area 1262 to facilitate rotation ofthe housing 1265 with respect to the handle 1260. The cylindricalhousing base insert 1266A defines the top of the cylindrical receptacle1266 and has sufficient clearance to facilitate operation of the trigger1267, which is mounted on a trigger pivot pin 1269 located in thehousing 1265. Accordingly, referring again to FIGS. 46 and 47, there issufficient space within the cylindrical housing base insert 1266A andthe cylindrical receptacle 1266 to facilitate pivoting of the trigger1267 on the trigger pivot pin 1269. Furthermore, the housing 1265 mayrotate with respect to the handle 1260 as illustrated in FIGS. 42-45 tofurther facilitate positioning of the crescent 101, illustrated in FIG.1, in a precise position in an incision or wound (not illustrated) forsuturing purposes.

As further illustrated in FIGS. 1 and 43-47 of the drawings the cradle1265 is pivotally seated in a friction-fit in a slot or opening in thehousing 1265, typically by means of a pair of pivot pin bosses 1279(FIGS. 44 and 45) that typically receive a sprocket pivot pin 1277, theends of which sprocket pivot pin 1277 project into the housing 1265 topivotally mount the cradle 1276A on the housing 1265. The cradle 1276Ais further characterized by a pair of U-shaped, oppositely-disposedreceptacle nocks 1276B which are spaced-apart in the cradle 1276A inorder to receive the extension tube 1200 in a secure friction or “slipfit”, such that the extension tube 1200 can be rotated 360-degrees alongthe longitudinal axis in the U-shape receptacle nocks 1276B with respectto the cradle 1276A to further facilitate a desired spatial orientationof the crescent 101 (FIG. 1) inside an incision or wound for suturingpurposes. As illustrated in FIGS. 46 and 47 of the drawings the triggerpivot pin 1269 extends through the housing 1265 and through an elongatedpivot pin hole 1273 in the trigger 1267 to facilitate upward anddownward, as well as pivotal movement of the trigger 1267 on the triggerpivot pin 1269, responsive to finger pressure applied to the finger pad1268.

Referring now to FIGS. 42-49 of the drawings and to FIGS. 48 and 49 inparticular, the bifurcated, geared upper segment 1272 of the trigger1267 is arcuate and is fitted with teeth 1272A for engaging the teeth ofa pair of sprocket gears 1276 when pressure is applied to the finger pad1268 of the trigger 1267, forcing the trigger 1267 upwardly against thetrigger pivot pin 1269 in the elongated pivot pin hole 1273, asillustrated in FIG. 48. Each of the two sprocket gears 1276 is centeredon and fixed to a sprocket 1275, having sprocket teeth 1275A, by meansof a sprocket pivot pin 1277. The sprocket pivot pin 1277 may also serveto pivotally mount the cradle 1276A in the housing 1265, although thecradle 1276A can be pivotally mounted in the housing 1265 by means ofseparate pins (not illustrated) extending through the cradle 1276A intothe friction-fit pivot pin bosses 1279, illustrated in FIGS. 44 and 45of the drawings. A trigger spring 1282 has one end attached to thetrigger 1267, typically by means of a trigger spring hole 1282A and theopposite end of the trigger spring 1282 is secured to a housingattachment boss 1282B, on the housing 1265, to bias the trigger 1267into disengagement with the sprocket gears 1276 in the relaxed positionillustrated in FIG. 47. As further illustrated in FIGS. 48 and 49 thegeared upper segment 1272 of the trigger 1267 is bifurcated to define atrigger gear slot 1274, which accepts the sprocket 1275, as illustratedin FIG. 48. Accordingly, it will be appreciated that the sprocket gears1276 fixed to each side of the sprocket 1275, engage a separate set ofteeth 1272A on the bifurcated geared upper segment 1272 of the trigger1267 to facilitate a more secure and positive rotation of the sprocketgears 1276 and the sprocket 1275 in concert, responsive to manipulationof the trigger 1267 by an operator, as hereinafter further described.

Referring to FIGS. 1 and 50-53 of the drawings the transmission tube1200 is rotatably seated in the pivoting cradle 1276A in a position suchthat the reciprocating input collar 1216 extends into the slot oropening provided in the housing 1265 immediately above the cradle 1276A,as illustrated in FIG. 50. Furthermore, as further illustrated in FIG.51, from which the housing 1265 has been removed for brevity, it will beappreciated that the rotating sprocket 1275, mounted on the sprocketpivot pin 1277, engages the reciprocating collar ridge 12161 of thereciprocating input collar 1216 by means of the respective sprocketteeth 1275A, such that rotation of the sprocket 1275 in thecounterclockwise direction by trigger action as viewed in FIG. 51,forces the reciprocating input collar 1216 to slide in the direction ofthe arrow on the extension tube 1200. Since the reciprocating collarridge 1216 I, fixed to the reciprocating input collar 1216 is round(FIGS. 51 and 53), this configuration facilitates selective rotation ofthe extension tube 1200 in the cradle 1276A through a 360-degree rangealong, the longitudinal axis to position the crescent 101 (illustratedin FIG. 1) in a desired orientation inside a wound or incision (notillustrated) without disturbing engagement of the reciprocating collarridge 1216 I with one of the sprocket teeth 1275A on the sprocket 1275.Referring again to FIG. 51 of the drawings it will be appreciated thatthe sliding range of motion of the reciprocating input collar 1216 onthe extension tube 1200 is limited to a short space between the twoU-shaped receptacle nocks 1276B of the cradle 1276A.

Referring now to FIGS. 47 and 53 of the drawings the trigger 1267 isillustrated in relaxed configuration with the teeth 1272A on thebifurcated and geared upper segment 1272 slightly spaced from thecorresponding teeth on the sprocket gears 1276, by operation of the biasin the trigger spring 1282 and the slack in the elongated pivot pin hole1273. Furthermore, the sprocket 1275 is so positioned on the sprocketpivot pin 1277, along with the pair of sprocket gears 1276, that one ofthe sprocket teeth 1275A engages the reciprocating collar ridge 1216 Iof the reciprocating input collar 1216. As further illustrated in FIG.53 the cradle 1276A supports the extension tube 1200 in the horizontalconfiguration and further illustrated is a spring-eye rod 1216Ghorizontally situated inside the extension tube 1200 and fitted with aspring-eye 1216D for receiving a projecting spring eye hook 1216C. Theelongated spring-eye rod 1216G extends through a fixed spring eye rodguide post 1216H, which is secured to the extension tube 1200 from theinside, and a return spring 1216A is provided on the spring-eye rod1216G between the spring-eye rod guide post 1216H and a spring-eye rodcap 1216E, terminating the extending end of the spring-eye rod 1216G,opposite the spring-eye 1216D. Accordingly, extension of the spring-eyerod 1216G in the extension tube 1200 stretches the return spring 1216Aand biases the spring-eye rod 1216G rearwardly for purposes which willbe hereinafter further described.

Referring now to FIGS. 1, 48, 54, 55 and 56 of the drawings, whenpressure is applied to the finger pad 1268 and the trigger 1267 in thedirection of the arrow, the respective teeth 1272A on the bifurcatedgeared upper segment 1272 of the trigger 1267 are forced forwardly intoengagement with the corresponding teeth on the pair of sprocket gears1276 as the trigger 1267 rises in the elliptically-shaped elongatedpivot pin hole 1273, until the trigger 1267 engages the trigger pivotpin 1269. Continued finger pressure on the trigger 1267 forces thesprocket 1275 to rotate in the counterclockwise direction as pressure isapplied to the two sprocket gears 1276 and the reciprocating collarridge 1216 I and the reciprocation input collar 1216 are caused to moverearwardly, as illustrated by the collar arrow 1216J in FIG. 55.Rearward movement of the reciprocating input collar 1216 occurs aspressure is maintained on the trigger 1267 and the teeth 1272A traversethe two sprocket gears 1276 until the entire array of teeth 1272A on thebifurcated geared upper segment 1272 of the trigger 1267 traverse thesprocket gears 1276. This continued pressure against the trigger 1267also maintains bias in the trigger spring 1282 to facilitate return ofthe trigger 1267 to its original position illustrated in FIG. 53 and inphantom in FIG. 55, when finger pressure is released from the trigger1267. Accordingly, as further illustrated in FIG. 55 when the respectiveteeth 1272A on the geared upper segment 1272 fully traverse thecorresponding sprocket gears 1276 the reciprocating input collar 1216has moved to its maximum extended sliding position on the extension tube1200 from the position illustrated in phantom. This action also forcesthe spring-eye hook 1216C, the spring-eye 1216D and the spring-eye rod1216G rearwardly against the extension bias of the return spring 1216A,due to attachment of the spring eye hook 1216C to the input collartubular base 1216N (FIG. 56). Release of finger pressure from thetrigger 1267 immediately disengages the respective teeth 1272A from thesprocket gears 1276 as the trigger 1267 shifts on the trigger pivot pin1269 by operation of the trigger spring 1282 and the elongated pivot pinhole 1273, to relocate the trigger 1267 back into the positionillustrated in phantom in FIG. 55 and in FIGS. 53 and 54. Accordingly,as the trigger 1267 disengages the sprocket gears 1276, the sprockettooth 1275A that engages the reciprocating collar ridge 1216 I of thereciprocation input collar 1216 also disengages the collar ridge 1261 Iat the extreme rearward movement of the reciprocation input collar 1216responsive to rotation of the sprocket 1275. The reciprocation inputcollar 1216 then returns to its original position illustrated in FIGS.53 and 54 and in phantom in FIG. 55, by operation of the return spring1216A. Additional finger pressure applied to the trigger 1267 thusrepeats the operation illustrated in FIGS. 53-55, moving thereciprocating input collar 1216 through another sliding sequence on thetransmission tube 1200 and sequentially forcing the spring-eye rod 1216G rearwardly against the bias of the return spring 1216A to drive theneedle (not illustrated) around the crescent 101 (FIG. 1) as hereinafterfurther described.

Referring now to FIGS. 55, 56 and 57 of the drawings in a preferreddesign of this embodiment of the invention the spring-eye hook 1216C,attached to the spring-eye 1216D of the spring-eye rod 1216G, projectsthrough a spring-eye hook slot 1211E, as particularly illustrated inFIG. 56. Furthermore, the spring-eye rod guide post 1216H is attached tothe transmission tube 1200 at a spring plate 1216B, as furtherillustrated in FIG. 56. Moreover, a pair of drive cable input stops1247A and 1247B are fitted to the drive cable 1247 and are positioned oneither side of a forked transmission rod 1216F, the forked transmissionrod slot 1216 K of which receives the drive cable 1247. The forkedtransmission rod 1216F extends through a reciprocation input forked rodslot 1211C, as further illustrated in FIG. 56. One of the crescent anglearticulation cables, 1256A, also extends through the forked transmissionrod 1216F and parallels the drive cable 1247. FIG. 57 furtherillustrates positioning of the direction cable 1248 with respect to thedrive cable 1247, as well as the location of the four crescent anglearticulation cables 1256A, 1256B, 1256C and 1256D in the transmissiontube 1200.

Referring now to FIGS. 58-64 of the drawings and initially to FIG. 58,the lever 1251 mounted in the selection bearing 1252 at the operatingend of the transmission tube 1200 is used to control articulation of thecrescent 101 by operation of the crescent angle articulation cables1256A, 1256B, 1256C and 1256D, as heretofore overviewed. The selectionbearing 1252 movably fits in a selection bearing socket 1253C and themounting post 1251A of the lever 1251 extends through a lever mount hole1252C in the center of the selection bearing 1252, as illustrated.Accordingly, the lever 1251 is articulated with finger pressure alongwith the selection bearing 1252 in the selection bearing socket 1253C tocontrol the crescent angle articulation cables 1256A, 1256B, 1256C and1256D, as hereinafter further detailed. Also illustrated in FIG. 58 arethe top insert 1205B, the top pulley 1210B, the bottom insert 1205A andthe bottom pulley 1210A, in proximity to the drive cable 1247 and thedirection cable 1248 with respect to the operating end of thetransmission tube 1200. Connection of these elements and operation ofthe lever 1251 will be hereinafter further described.

As further illustrated in FIGS. 59-64 the extending end pairs of thelooped drive cable 1247 and direction cable 1248 project from theoperating end of the transmission tube 1200 forwardly through thetransmission tube 1200, the transition cone 1245, the extension tube1240 and project from the transition guide cone 1238 through theclearance tunnels 775A and 7751A, to the respective drive access cableextensions 140, connected to the reciprocating driver 108 and thedirection setting access cable extensions 141, extending from the drivedirection setting plate 134, respectively. As illustrated, the end pairsof the drive cable 1247 and direction cable 1248 converge at the jointball 780 and project through a central opening 780A therein to therespective drive access cable extensions 140 and direction settingaccess cable extensions 141. Similarly, the crescent angle articulationcables 1256A, 1256B, 1256C and 1256D project through transition guidecone openings 1238A, 1238B, 1238C and 1238D, respectively, provided inthe transition guide cone 1238 and extend to spaced-apart, fixedattachment to the four base corners 776A, 776B, 776C and 776D of thesocket 775, as illustrated in FIG. 5 and heretofore described. Theopposite ends of the crescent angle articulation cables 1256A, 1256B,1256C and 1256D connect to the selection bearing 1252 as furtherhereinafter described, to facilitate selective manipulation of thecrescent angle articulation cables 1256A, 1256B, 1256C and 1256D byfinger and thumb operation of the lever 1251 and corresponding movementof the selection bearing 1252 with respect to the fixed selectionbearing socket 1253. This manipulation results in articulation of thecrescent 101 to the illustrative positions illustrated in FIGS. 62-64 ofthe drawings.

Referring now to FIGS. 1 and 65-78 of the drawings, the directionactuator 1214 is illustrated and includes a disc-shaped actuator boss1214B extending from a tubular base 1214C, that slidably encircles thetransmission tube 1200. The direction actuator 1214 is mounted on atubular slide switch mount body 1211, bounded by a pair of fixedpressure opposing rings 1211A and fitted with a pair of slide switchbody detents 1218, that sequentially receive a pair of directionactuator bosses 1218A, located on the underside of the tubular base1214C of the direction actuator 1214. As further illustrated in FIGS.65-68 of the drawings, the drive cable 1247 and direction cable 1248 areillustrated extending through the transmission tube 1200 and the drivecable 1247 is fitted with a drive cable spring stop 1215C, while thedirection cable 1248 is provided with a similar direction cable springstop 1215D. The drive cable spring stop 1215C and the direction cablespring stop 1215D are connected by a direction mount—to drive mountspring 1215A and a direction connecting rod 1217 projects through acoextensive transmission tube slide slot 1200A and a mount body slideslot 1211B, located in the transmission tube 1200 and the slide switchmount body 1211, respectively, immediately adjacent to the drive cablespring stop 1215C and the direction cable spring stop 1215D (FIG. 65). Adirection connecting rod mounting slot 1214A (FIG. 68) is also providedin the tubular base 1214C of the direction actuator 1214 to receive thedirection connecting rod 1217 and a direction connecting rod—todirection mount spring 1215B connects the mounting boss 1217C on thedirection connecting rod 1217 to the direction cable spring stop 1215D.Accordingly, referring again to FIGS. 1 and 65-67 of the drawings,sliding manipulation of the direction actuator 1214 on the slide switchmount body 1211 fixed to the transmission tube 1200, positions thedirection connecting rod 1217 in a selected position in the coextensivetransmission tube slide slot 1200A and mount body slide slot 1211B,extending through the transmission tube 1200 and the slide switch mountbody 1211, respectively. This action also moves the drive cable 1247 andthe direction cable 1248 in the selected direction inside thetransmission tube 1200, as illustrated in FIGS. 66 and 67, for,selectively locking the fixed way direction setting plate 136 (notillustrated) in a selected position on the case 102 (not illustrated) inthe crescent 101 (illustrated in FIG. 1) and determining the directionof rotation of the needle 50 (not illustrated) in the crescent 101, ashereinafter further described.

Referring now to FIGS. 1, 58, 59, 65-68, 75 and 76 of the drawingslocking of the fixed way direction setting plate 136 in a specificposition with respect to the case 102 of the device depends upon thepositioning of the drive cable 1247 and the direction cable 1248 in thetransmission tube 1200. Both the drive cable 1247 and the directioncable 1248 are arranged in a loop at the operating end of thetransmission tube 1200, as illustrated in FIGS. 58 and 75 of thedrawings. The free ends of the drive cable 1247 are connected to the twodrive access cable extensions 140 extending from the reciprocatingdriver 108 and the free ends of the direction cable 1248 are attached tothe pair of direction setting access cable extensions 141, projectingfrom the drive direction setting plates 134 as illustrated in FIG. 59and as heretofore described. The opposite loop ends of the drive cable1247 and the direction cable 1248 are extended around the top pulley1210B, rotatably positioned in the top insert 1205B and the bottompulley 1210A, rotatably positioned in the bottom insert 1205A,respectively (FIGS. 75 and 76). This mechanical arrangement facilitatesmovement of the drive cable 1247 and the direction cable 1248 around thetop pulley 12101B and bottom pulley 1210A, respectively, to manipulateboth the reciprocating driver 108 and the drive direction setting plate134 (and set the underlying fixed way direction setting plate 136 in thecase 102) responsive to manipulation of the direction actuator 1214, asillustrated in FIGS. 65-67 and as heretofore described. The directionconnecting rod—to direction mount spring 1215B and the directionmount—to drive mount spring 121 SA serve to provide a lag in therelative positions of the drive cable 1247 and the direction cable 1248and thus, rotation of the reciprocating driver 108 and the companiondrive direction setting plate 134 (with the fixed direction settingplate 136 in a selected setting), for purposes which will be hereinafterdescribed. This lag is illustrated in the opposite sliding positions ofthe direction actuator boss 1214B in FIGS. 65-67.

Referring to FIGS. 1, 58, 59 and 75-78 of the drawings the top insert1205B is seated on the bottom insert 1205A in the transmission tube 1200such that the two inserts may slide longitudinally with respect to eachother. The top pulley 1210B is rotatably secured to the top insert 1205Bby means of a pulley pin 1210C and in like manner, the bottom pulley1210A is rotatably attached to the bottom insert 1205A by means of acompanion pulley pin 1210C (FIGS. 76 and 77). As further illustrated inFIGS. 75 and 76 the top pulley 1210B and the bottom pulley 1210A arejournalled for rotation on the respective pulley pins 1210C in a cavityor opening provided in the respective top insert 1205B and bottom insert1205A, such that the looped end (FIG. 58) of the drive cable 47 can belooped around the top pulley 1210B, while the looped end of thedirection cable 1248 is looped around the bottom pulley 1210A. Asheretofore described, the pairs of extending ends of the drive cable1247 and the direction cable 1248 project through the transmission tube1200 to anchor in the respective drive access cable extension 140 anddirection setting access cable extension 141. The top insert 1205B andbottom insert 1205A are further provided with four longitudinal,radially spaced-apart cable insert clearance grooves 1255 to accommodatethe crescent angle articulation cables 1256A, 1256B, 1256C and 1256D asillustrated in FIGS. 76 and 78. This arrangement facilitates sliding ofthe respective crescent angle articulation cables 1256A, 1256B, 1256Cand 1256D with respect to the top insert 1205B and the bottom insert1205A, responsive to operation of the lever 1251 and the selectionbearing 1252, to which one end of each of the respective crescent anglearticulation cables 1256A, 1256B, 1256C and 1256D is connected. Thisaction manipulates the crescent 101, which receives the opposite ends ofthe crescent angle articulation cables 1256A, 1256B, 1256C and 1256D atthe four corners of the socket 775 (FIG. 5), as hereinafter described.Insert tension threaded holes 1205E are provided in the respective endsof the top insert 1205B and the bottom insert 1205A to facilitateinsertion of adjusting bolts (not illustrated) for independentlyadjusting the linear positions of the top insert 1205B and the bottominsert 1205A, respectively, in the transmission tube 1200 forapplication of tension to the respective drive cable 1247 and directioncable 1248, as deemed necessary while operating the device.

Referring now to FIGS. 1, 58, 59-64, 79 and 80 of the drawings, therespective operating ends of the crescent angle articulation cables1256A, 1256B, 1256C and 1256D are secured to the selection bearing 1252(FIG. 79) at the operating end of the transmission tube 1200, typicallyby means of cable set screws 1252A, seated in corresponding bearingcable slots 1252B provided in the selection bearing 1252. A levermounting hole 1252C is provided in the center of the selection bearing1252 to accommodate a mounting post 1251A element of the lever 1251, asillustrated in FIG. 58. Furthermore, the selection bearing 1252 ispivotally seated in the extension clearance hole 1253C of the selectionbearing socket 1253, having a socket mounting extension 1253A, formounting the selection bearing socket 1253 on the operating end of thetransmission tube 1200 (FIG. 58). Accordingly, the lever 1251 can bemanipulated with a finger and thumb to pivot the selection bearing 1252in the selection bearing socket 1253 and effect selective tensioning ofthe respective crescent angle articulation cables 1256A, 1256B, 1256Cand 1256D, with a corresponding articulation of the crescent 101, fixedto the respective crescent angle articulation cables 1256A, 1256B, 1256Cand 1256D at the respective base corners 776A, 776B, 776C and 776D ofthe socket cavity base 776 element of the socket 775 (FIG. 80). Thejoint ball 780 is fixedly mounted to the extending end of the transitionguide cone 1238 and receives the socket 775 in rotatable, articulatingrelationship, as heretofore described. Manipulation of the lever 1251 istherefore effective to facilitate universal movement of the crescent 101with respect to the transition guide cone 1238, as illustrated in FIGS.59-64 of the drawings.

Referring now to FIGS. 1, 40A and 80-83 of the drawings a threadincrementing accessory 1101 is illustrated for mounting on one end ofthe crescent 101 and handling the thread 50A attached to the middle ofthe crescent-shaped needle 50. Typically, when used alone, the threadincrementing accessory 1101 is mounted on the receiving arm 1011 Bopposite the advancing arm 101A of the crescent 101, as illustrated inFIGS. 40A and 80-82 of the drawings. It will be appreciated from aconsideration of FIGS. 40A and 80-82 that the crescent-shaped needle 50is seated in the fixed way 104 element of the crescent 101 such that itcan completely traverse the crescent 101 and the gap 105 (FIG. 6) in thecrescent 101, between the advancing arm 101A and the receiving arm 101B,as well as the thread incrementing accessory 1101, with the thread 50following the course of the needle 50. The thread incrementing accessory1101 is designed to handle and increment the loose thread leading threadhead portion 50D of the thread 50A, extending from the needle 50, as theneedle 50 traverses a material 100 to be sutured, as illustrated inFIGS. 80-83. Accordingly, referring again to FIG. 80 of the drawings theneedle 50 is rotating in the counterclockwise direction as viewed fromabove and first enters the material 100 at the entrance 100B and exitsthe material at the exit 100C, to create a continuous tunnel 100A(illustrated in phantom). The thread incrementing accessory 1101 thuspicks up the thread 50A as the needle 50 completes its traversal of thetunnel 100A and prevents entanglement of the thread 50A as the crescent101 is positioned for additional penetration of the material 100. Asillustrated in FIG. 81 of the drawings the thread head 50D of the thread50A may be engaged by a sliding hook 50E to manually take up the slackcreated by the thread incrementing accessory 1101 out of the thread 50Aas the needle 50 rotates and penetrates the material 100. The oppositeend or the thread tail 50C projects from the opposite end of thematerial 100 at the entrance 100B, as illustrated in FIGS. 80 and 81.FIG. 82 illustrates the technique of looping the severed thread tail 50Cof the thread 50A around the thread head 50D of the thread 50A as thethread head 50D projects from the exit 100C of the tunnel 100A in thematerial 100. This maneuver forms the basis for the first knot or sutureto be tied in the thread 50A, typically with the help of the threadincrementing accessory 1101. This knot or suture is substantiallycomplete as illustrated in FIG. 83, which illustrates knotting of thethread tail 50C and the thread head 50D of the thread 50A to secure twosegments of the material 100 together in a single suture or knot.

Referring now to FIGS. 1, 40A, 84-88 and 90-93 of the drawings thethread incrementing accessory 1101 is detailed and is characterized by afixed housing 1120, typically mounted on the advancing arm 101B of thecrescent 101 (FIG. 88). The fixed housing 1120 is defined byspaced-apart housing walls 1120B, with fixed blades 1114 extending fromthe rear portion of the housing walls 1120B, respectively, and highermovable blades 1112 and movable blades 1113, each having concave contactareas 1114A, projecting from corresponding fins 1145, disposed in finslots 1146, respectively, provided in a movable housing 1115 positionedinside the fixed housing 1120 (FIG. 84). The higher movable blades 1112and the movable blades 1113 project into a guide slot 1126A provided inthe movable housing 1115 to accommodate and selectively engage thethread 50A at the concave contact surfaces 1114A, respectively, as theneedle 50 traverses the crescent 101 (FIG. 88). An actuation plate 1134is slidably disposed above the fixed housing 1120 and beneath themovable housing 1115. A second thread incrementing accessory 1101A mayalso be designed to seat on the case base 102A on the receiving arm 101Bend of the crescent 101, as illustrated in FIG. 89 of the drawings.

As further illustrated in FIGS. 4, 84, 90, 91, 92 and 94 of the drawingsa base 1121 closes the bottom of the fixed housing 1120 beneath theactuation plate 1134 and an access slot 1144A extends linearly throughthe base 1121 and tapers at the forward end to define a narrowing slot1144B at the forward end thereof. An access extension tab 1144 slidablyseats in the access slot 1144A and is fixed to the actuation plate 1134(FIG. 91), and the access extension tab 1144 receives a transmissionwire boss 1142 for attachment to one end of a power transmission wire1140 (FIG. 91). The power transmission wire 1140 extends through anopening in a mounting boss 1143 mounted on the base 1121 and receivingone end of a flexible tube 1141, which is secured to the mounting boss1143, the opposite end of which flexible tube 1141 terminates in asecond handle 1261, having a second handle trigger 1261B, attached tothe handle 1260, as illustrated in FIG. 4. A hinge 1121A bridges the gapbetween the rearward end of the access slot 1144A and a spreadingclearance notch 1121B, extending the access slot 1144A. Accordingly,operation of the second handle trigger 1261B in the second handle 1261(FIG. 4) in the manner hereinafter described facilitates slidingmovement of the access extension tab 1144 in the access slot 1144A andin the narrowing slot 1144B of the access slot 1144A to slide theactuation plate 1134 and the attached movable housing 1115 in the fixedhousing 1120 and handle the thread 50 during suturing, as hereinafterdescribed. As illustrated in FIGS. 91 and 92 a pair of pivotal bosses120A extend from the inside surfaces of the respective housing walls1120B of the fixed housing 1120 for engaging corresponding case bossgrooves 1120D in the case 102 and slidably securing the fixed housing1120 in the case 102.

Referring again to FIGS. 7, 84, 87 and 90C-91, 93, 94, and 95 of thedrawings the higher movable blades 1112 and movable blades 1113 aremounted in the movable housing 1115, slidably seated in the fixedhousing 1120, when the latter is typically mounted on the case 102 ofthe advancing arm 101B of the crescent 101 (FIG. 84). The angle ofconvergence of the higher movable blades 1112 and the movable blades1113 points rearwardly toward the receiving arm 101B. Furthermore, thepair of higher movable blades 1112 are positioned higher with respect tothe base of the movable housing 1115 than the movable blades 1113 (FIG.84). The rear portions of the respective higher movable blades 1112 andmovable blades 1113 define fins 1145 (FIG. 95), which are each pressedinto a tight fitting fin slot 1146 (FIGS. 84 and 93), shaped in the backof the blade recesses 1148, respectively, and bending of these blades isrestricted to a thin leaf section 1147 joining the fin 1145 to thecontact area 1149 of each of the higher movable blades 1112 and movableblades 1113, respectively (FIG. 95). Tabs 1118 and longer tabs 1118A,having triangular tab sections 1118B (FIG. 94), of the movable blades1113 and the higher movable blades 1112, respectively, extend downwardlythrough clearance holes 1124, respectively, in the movable base 1116 ofthe movable housing 1115, as illustrated in FIG. 94. The longer tabs1118A extend further downwardly from the higher location of the highermovable blades 1112, along with the tabs 1118, to reach alignedparallelogram holes 1138, provided in the actuation plate 1134, asillustrated in FIG. 94. Each of the tabs 1118 and longer tabs 1118A arecontrolled through these parallelogram holes 1138 by the sliding motionof the actuation plate 1134 with respect to the fixed housing 1120. Thiscontrol is implemented as the actuation plate 1134 reciprocates bysliding back and forth in the respective normal range of motion 1144Cand extended range of motion 1144D, respectively, over the access slot1144A and the narrowing slot 1144B that extends the access slot 1144A,as heretofore described and as illustrated in FIGS. 90C-91. Theactuation plate 1134 slides in the space between the base 1121 of thefixed housing 1120 and the base 102A of the case 102, as furtherillustrated in FIGS. 86, 90 and 90C-91. This reciprocation and contactwith the respective tabs 1118 and 1118A, causes the higher movableblades 1112 and the movable blades 1113 to flex inwardly against thethread 50A (FIG. 90C) when the thread 58 is located in the guide slot1126A by rotation of the needle 50 in the crescent 101, where contactwith the thread 50A then stops the flexing action. Additional movementof the actuation plate 1134 in the normal range of motion 1144Ccontinues to manipulate the respective tabs 1118 and the longer tabs1118A and by this action, forces the movable housing 1115 in theproximal direction to the rear extent of the range of its movement inthe fixed housing 1120.

It is sometimes necessary to use two thread incrementing accessories1101 and 1101A, one on the advancing arm 101A and one on the receivingarm 101B of the crescent 101, as illustrated in FIG. 89. Since thenumber of mechanical actuators must be held to a minimum, the threadincrementing accessories 1101 and 1101A have been designed to operatewith a single actuator. In order to accomplish these two functions withone remote actuation input, the angles of the tabs 1118 and the longertabs 1118A in each thread incrementing accessory 1101 are set in anearly perpendicular plane with respect to that of the higher movableblades 1112 and movable blades 1113, respectively. This mechanicalconfiguration facilitates reversal of the direction in which theactuation plate 1134 must travel in order to bend the respective highermovable blades 1112 and the movable blades 1113 into contact with theneedle 50. This activity facilitates use of the actuation plate 1134 toalso serve as a drive plate and pull the movable housing 1115 forwardly,respectively, while the higher movable blades 1112 and movable blades1113, respectively, are locked on the thread 50A, as hereinafter furtherdescribed.

Referring now to FIGS. 4, 90 and 91 of the drawings the actuation plate1134 is driven back and forth by a stiff, but flexible powertransmission wire 1140, which is housed within a flexible tube 1141provided within a main extension tube (not illustrated) that extends tothe proximal side of the joint ball 780 on to the second handle 1261.The opposite end of the flexible power transmission wire 1140 isconnected to the wire attachment extension boss 1142, provided on theaccess extension tab 1144 that extends down from fixed attachment to theactuation plate 1134. The access extension tab 1144 passes through theslot 1144 in the base of the fixed housing 1120. The flexible tube 1141is fixed to the mounting boss 1143 attached to the base 1121 of thefixed housing 1120, near the end of the access slot 1144A.

The simplest technique of pulling and controlling thread when suturingusing the cycling suturing and knot-tying device of this invention isuse of a sliding hook 50E illustrated in FIG. 81 of the drawings. Thehook snags the thread 50A, allowing it to slide across the curved hooksection and form a loop as the hook is drawn away from the stitch in thedirection of the arrow. Various types of sliding hooks are known in theart and are currently used in suturing operations.

Referring now to FIGS. 98-108 of the drawings in another preferredembodiment of the invention a semi-automatic technique for handling thethread 50A during the suturing operation while using the cyclingsuturing and knot-tying device includes a thread pulling hook/unhookdevice 1000 which may be implemented as a double installation version1000A (FIGS. 98 and 104-106), depending upon the nature of the procedureundertaken. As further illustrated in FIGS. 98-103 and in FIG. 102 inparticular, each of the inner housing tubes 1045 includes a retractablehook body 1010, fitted with a curved profile slot defined byspaced-apart, parallel rear hook ejecting slopes 1016 and correspondingparallel forward hook faces 1012 and having a built-in, slidablydisposed grip/eject/cut blade 1020, as further illustrated in FIGS. 99and 100. The grip/eject/cut blade 1020 is further fitted with a rearwardgripping/cutting overhang 1026, a preparatory blade slope 1024 at theextending front end thereof and a forward blade ejecting slope 1022,oppositely disposed from and extending outwardly of thegripping/cutting/overhang 26. The grip/eject/cut blade 1020 is slidablydisposed in a longitudinal blade slide slot 1010A, shaped in the hookbody 1010 (FIG. 102), where the spaced-apart pair of hook faces 1012terminate forwardly of the corresponding pair of hook ejecting slopes1016 and spaced-apart, planar preparatory thread lifting slopes 1014terminate the front end of the hook body 1010. The hook body 1010 andslidably enclosed grip/eject/cut blade 1020 are seated in an innerhousing tube 1045, such that the hook body 1010 is fixed to the innerhousing tube 1045 and the grip/eject/cut blade 1020 is able to slidewith respect to both the inner housing tube 1045 and the hook body 1010.A plunger disc 1065 is provided on the inner housing tube 1045 asfurther illustrated in FIG. 102 and both the inner housing tube 1045 andthe plunger disc 1065 are enclosed within a housing tube enlargedsection 1042. In like manner, a second plunger disc 1065A is fixed tothe inner housing tube 1045, spaced-apart from the plunger disc 1065 andalso enclosed in the housing tube enlarged section 1042. The plungerdisc 1065 and second plunger disc 1065A serve to center the innerhousing tube 1045 in the housing tube enlarged section 1042. Anactuation wire 1050 is slidably disposed inside the inner housing tube1045 as further illustrated in FIG. 102 and is secured at one end to thegrip/eject/cut blade 1020 for slidably manipulating the grip/eject/cutblade 1020 in the blade slide slot 1010A in the hook body 1010, byoperation of the actuation wire 1050, as hereinafter further described.

As further illustrated in FIGS. 102 and 102A of the drawings the hookbody 1010 is further characterized by a hook open profile 1018 (FIG.102A) that defines 1 a hook containment slot 1070 extending from theparallel hook ejecting slopes 1016 to the parallel hook faces 1012, toaccommodate a length of the thread 50A for manipulating and cutting thethread 50A, as hereinafter further described.

Referring now to FIGS. 102 and 103 of the drawings the grip/eject/cutblade 1020 is illustrated fixed to the extending end of the actuationwire 1050 and is provided with a blade open profile 1028, that extendsfrom the blade ejecting slope 1022 to the grip/cutting overhang 1026.Further illustrated is the preparatory blade slope 1024 provided on theextending end of the grip/eject/cut blade 1020.

Referring to FIGS. 99-103 of the drawings the actuation wire 1050,enclosed within the inner housing tube 1045, the latter of which may bealternatively telescoped inside the smaller auxiliary housing tube 1040A(FIG. 103), can be manipulated as hereinafter further described to causethe grip/eject/cut blade 1020 to extend or retract in the blade slideslot 1010A of the hook body 1010, as desired. For example, as furtherillustrated in FIG. 102 the actuation wire 1050 can be pushed forwardlyto slidably displace the grip/eject/cut blade 1020 forwardly in theblade slide slot 1010A in the direction of the blade extension arrow1000F, to mismatch the gripping/cutting overhang 1026 in thegrip/eject/cut blade 1020, with the hook ejecting slopes 1016 and hookfaces 1012 in the hook body 1010. Alternatively, the grip/eject/cutblade 1020 can be reversed by reverse operation of the actuation wire1050 to slidably displace the grip/eject/cut blade 1020 in the oppositedirection with respect to the hook body 1010 and align thegripping/cutting overhang 1026 with the hook ejecting slopes 1016 tofacilitate a corresponding blade open profile 1028 and hook open profile1018 of the hook/unhook device 1000 as illustrated in FIGS. 99 and 103of the drawings. Under these circumstances, as further illustrated inFIGS. 99 and 100, a loop of the thread 50A can be inserted in the bladeopen profile 1028 (FIG. 99) and the grip/eject/cut blade 1020 then movedin the forward direction by forward manipulation of the actuation wire1050 in the direction of the blade extension arrow 1000F, as illustratedin FIG. 102, to sever the loop of thread 50A (FIG. 100). Still furtherin the alternative, and referring again to FIGS. 99 and 101 of thedrawings, the thread 50A can be placed in the blade open profile 1028and manipulated as illustrated by the device retraction arrow 1000E to adesired position during suturing. Under circumstances where it isdesired to eject the uncut loop of thread 50A from the blade openprofile 1028 after so manipulating the segment of thread 50A, thegrip/eject/cut blade 1020 can be manipulated in the opposite directionillustrated by the blade retraction arrow 1000G (FIG. 101), causing theblade ejecting slope 1022 to contact the loop of thread 50A and forcethe thread loop from the blade open profile 1028. This operation iseffected by reverse movement of the actuation wire 1050 fixed to thegrip/eject/cut blade 1020, as hereinafter further described.Accordingly, the hook/unhook device 1000 can be used to handle thread asfollows: the device can grip the thread as necessary; it can move thethread without gripping it; the device can grip and cut the thread; andit can grip and then cut the thread, all as described above.

Referring now to FIGS. 98, 102 and 104-108 of the drawings, it will beappreciated that one or more of the hook/unhook devices 1000 can beused, as in the double installation version 1000A illustrated in FIGS.98 and 104-106. The double installation version 1000A is characterizedby a double installation advancing arm side hook 1000B and a doubleinstallation receiving arm side hook 1000C, which are identical indesign. Each of the double installation advancing arm side hook 1000Band double installation receiving arm side hook 1000C is typicallycharacterized by an inner housing tube 1045 (FIG. 102) that extends intoa corresponding and separate housing tube enlarged section 1042 or anauxiliary housing tube 1040A (FIG. 103). Furthermore, each of the doubleinstallation advancing arm side hook 1000B and double installationreceiving arm side hook 1000C have a hook/unhook device 1000, includinga hook body 1010 and a slidably operating grip/eject/cut blade 1020slidably disposed in the blade slide slot 1010A of the hook body 1010 asfurther illustrated in FIG. 102. Accordingly, the design and operationof the double installation version 1000A, including the doubleinstallation receiving arm side hook 100C and the double installationadvancing arm side hook 1000B, is substantially the same as thatdescribed above with respect to the hook/unhook device 1000 illustratedin FIGS. 98-103.

Referring now to FIGS. 105 and 106 of the drawings in a preferredsuturing embodiment, knots or sutures may be tied in close quartersinside a wound or incision using the double installation version 1000Aof the hook/unhook device 1000 by manipulating the respective doubleinstallation advancing arm side hook 1000B and double installationreceiving arm side hook 1000C to engage the thread tail 50C and threadhead 50D, respectively, as illustrated. This engagement is effected asheretofore described with respect to FIGS. 98-103, and while the innerhousing tube 1045 of the double installation advancing arm side hook1000B is extended from the auxiliary housing tube 1040A in the directionof the device extension arrow 1000D, the corresponding inner housingtube 1045 of the double installation receiving arm side hook 1000C isretracted inside the housing tube 1040 in the direction of the deviceretraction arrow 1000E, to tighten the entwinements 50G, as furtherillustrated in FIG. 105. Continued sequential extension and retractionof the respective double installation advancing arm side hook 1000B anddouble installation receiving arm side hook 1000C in this manner effectsa tight knot or suture joining the material 100 to the additionalmaterial 1000D as further illustrated in FIG. 106.

Referring now to FIGS. 102, 107 and 108 of the drawings the operationalcomponents of the hook/unhook device 1000, as well as the doubleinstallation version 1000A illustrated in FIGS. 104-106, areillustrated. As heretofore described, the hook/unhook device 1000,longitudinally and in the double installation version 1000A, eachinclude an inner housing tube 1045, connected to a hook body 1010receiving a sliding grip/eject/cut blade 1020, which inner housing tube1045 is typically encased at a housing tube enlarged section 1042 in ahousing tube 1040, as illustrated in FIGS. 107 and 108. It will beappreciated from a consideration in FIGS. 104-106 of the drawings thateach of the double installation advancing arm side hooks 1000B anddouble installation receiving arm side hooks 1000C have a typicallyidentical separate housing tube 1040 and auxiliary housing tube 1040A,respectively each with a corresponding housing tube enlarged section1042, for receiving and allowing bending of the respective correspondinginner housing tube 1045. As further illustrated in FIGS. 107 and 108 thehousing tube 1040 is further typically equipped with a crescent mount1055 and a tubular handle attachment mount point 1058A, which aresimilar in design and are spaced-apart on the length of the housing tube1040, as illustrated. As further illustrated in FIG. 108 the plungerdisc 1065 and second plunger disc 1065A are fixed to the correspondinginner housing tube 1045 that projects through the housing tube 1040 andthe rear end of the inner housing tube 1045 receives a three-positionswitch body 1058C, between which is sandwiched a three-position switchactuator 1058D, as illustrated in FIG. 108. It will be appreciated froma consideration of FIG. 108 that the inner housing tube 1045 slideswithin the housing tube 1040 and is aided and centered in that slidingaction by the plunger disc 1065 and second plunger disc 1065A, that acttogether as spacers. Furthermore, referring again to FIG. 102 of thedrawings the actuation wire 1050 slides within the inner housing tube1045 as heretofore described. Moreover, as illustrated in FIG. 108, bothof the three position switch bodies 1058C are fixed to the inner housingtube 1045, while the larger three position actuator 1058D is attached tothe actuation wire 1050. Accordingly, manipulation of the three positionactuator 1058D between the two fixed three position switch body 1058Celements facilitates sliding operation of the grip/eject/cut blade 1020in the hook body 1010, to either cut segments of the thread 50A (FIG.100) or manipulate segments of the thread 50A and then eject thosesegments from the blade open profile 1028 as illustrated in FIG. 101.Manipulation of the switch bodies 1058C in concert extends and retractsthe inner housing tube 1045 with respect to the housing tube 1040.

Referring again to FIGS. 98 and 108 of the drawings, in a preferredembodiment of the invention the flexible outer housing tube 1040 istypically attached to the underside of the crescent 101 by means of thecrescent mount 1055 and, in the case of the double installationadvancing arm side hook 1000B and double installation receiving arm sidehook 100C illustrated in FIGS. 104-106 of the drawings, both can beattached to the crescent 101 by means of the respective crescent mounts1055. The respective flexible housing outer tubes 1040, or either ofthem in case of solo use, are typically secured to the second handle1261 by means of the tubular handle attachment points 1058A. Therespective inner housing tubes 1045 are secured to the second handletrigger 1261B for actuation of the grip/eject/cut blade 1020, asheretofore described.

In operation, under circumstances where the cycling suturing andknot-tying device of this invention is utilized as illustrated in FIGS.1-3 of the drawings without the thread incrementing accessory or thehook/unhook device, the cycling suturing and knot-tying device is usedas follows. The device is initially grasped by the handle 1260 with onefinger on the trigger 1267 and the transmission tube 1200 is selectivelyaxially rotatably oriented in the cradle 1276A and tilted with thecradle 1276 with respect to the handle 1260, to comfortably position thecrescent 101 in an incision or wound adjacent to a material 100 to besutured (FIG. 62). As further illustrated in FIGS. 62-64 of the drawingsthe crescent 101 itself may be manipulated by operation of the jointball 780, seated in the socket 775, into any one of the threeillustrative positions and any other necessary position or positionswith respect to the material 100, by manipulation of the lever 1251illustrated in FIGS. 1-4. Finger and thumb manipulation of the lever1251 selectively tensions the four crescent angle articulation cables1256A, 1256B, 1256C and 1256D, illustrated in FIG. 41 of the drawings,to achieve the desired orientation of the crescent 101 with respect tothe material 100 to be sutured, typically in a configuration andposition such as that illustrated in FIG. 62. The arcuate needle 50,provided with a length of thread 50A, typically attached to the centerthereof, is caused to rotate either in the clockwise or thecounterclockwise direction to extend a length of thread 50A through thematerial 100 following the needle 50, as further illustrated in FIG. 62.Traversal of the needle 50 around the crescent 101 is effected bysqueezing the trigger 1267 while gripping the handle 1260 on the device.This action rotates the sprocket 1275 (FIGS. 55 and 56) in the directionindicated by the arrow 1257A to slidably displace the reciprocationinput collar 1216 on the transmission tube 1200 and apply tension to thelooped drive cable 1247 in the direction of the arrow 1257 at the drivecable input stops 1247A and 1247B, since the forked transmission rod1216F is attached to the reciprocation input collar 1216 (FIG. 56). Thetwo free ends of the looped drive cable 1247 are, in turn, connected tothe two spaced-apart drive access cable extensions 140 attached to thereciprocating driver 108 (FIG. 6). In a preferred embodiment of theinvention depression of the trigger 1267 exerts a force on the driveaccess cable extensions 140 and causes the reciprocating driver 108 andthe drive direction setting plate 134 to traverse the case 102.Typically one full depression of the trigger 1267 results in a completeincrementation of the needle 50 in the crescent 101 in a directiondetermined by manipulation of the direction actuator 1214 illustrated inFIG. 65, as hereinafter further described. Accordingly, when an exactpositioning of the crescent 101 with respect to the material 100 to besutured is effected in the wound or incision, continued, repetitivefinger pressure on the trigger 1267, biased for return by the triggerspring 1282, effects multiple incremental passages of the needle 50through the material 100 at intervals determined by the operator, withthe thread 50A following the needle 50 through the needle opening ineach repetition. Large or small adjustments can be made during thesuturing operation to position the crescent 101 in a more optimum andcomfortable position by selectively and incrementally axially rotatingthe transmission tube 1200 in the cradle 1276A, manipulating the lever1251 to change the angle of articulation of the crescent 101 withrespect to the transmission tube 1200 and rocking or tilting the cradle1267A and the seated transmission tube 1200 with respect to the handle1260, in large or small increments. Accordingly, it will be appreciatedfrom a consideration of the design of the device that the crescent 101can be placed and maintained in a precise position or positionscomfortable to the operator for optimum stitching of the material 100 inboth large and very small incision and wound openings in a fast andefficient manner.

As heretofore described, the direction of rotation of the arcuate needle50 in the crescent 101 is selected by operation of the directionactuator 1214, as further illustrated in FIG. 65. Sliding of theactuator boss 1214B and the corresponding tubular base 1214C on theunderlying slide switch mount body 1211 between the spaced-apartpressure opposing rings 1211A, effects corresponding tensioning, firstof the direction cable 1248 and then the drive cable 1247. Since the twoends of the drive cable 1247 are attached to the spaced-apart pair ofdrive access cable extensions 140 extending from the reciprocatingdriver 108 and the two ends of the direction cable 1248 are attached toa pair of spaced-apart direction setting access cable extensions 141extending from the drive direction setting plate 134, manipulation ofthe actuator boss 1214B effects rotation of first, the drive directionsetting plate 134 and then the reciprocating driver 108, along with theunderlying fixed way direction setting plate 136, on the case 102 in thecrescent 101 (FIG. 6). Accordingly, as the actuator boss 1214B isslidably manipulated as illustrated in FIG. 65 and is adjusted such thatthe direction actuator boss 1218A on the tubular base 1214C engages theslide switch body detent 1218 in the slide switch mount body 1211, theneedle 50 is typically set for rotation in the counterclockwisedirection. This needle rotation setting is effected as the directioncable 1248 is initially tensioned by operation of the directionconnection rod-to-direction mount spring 1215B, attached to the mountingboss 1217C and carried by the sliding direction actuator boss 1218A(FIG. 66). This action rotates the drive direction setting plate 134 andthe fixed way direction setting plate 136 together with respect to thecase 102 and the crescent 101, in the clockwise direction as illustratedin FIGS. 36 and 37 of the drawings. As further illustrated in FIGS. 36and 37 and as heretofore described, the fixed way direction settingplate 136 is fitted with a detent 137B and an adjacent entrance stop137D, as well as a clearance recess 137F and a range stop 137H, thelatter terminating the forward end of the clearance recess 137F,typically on the receiving arm 101B of the crescent 101. As heretoforedescribed, like components are provided on the opposite or typically,the advancing arm 101A of the crescent 101. Reverse, or clockwiserotation of the needle 50 simply reverses the respective advancing andreceiving arm functions. Accordingly, as illustrated in FIGS. 38 and 39of the drawings, responsive to adjustment of the direction actuator1214, the drive direction setting plate 134 is caused to first traversethe fixed case 102 in the counterclockwise direction by pressure appliedto the spaced-apart direction setting access cable extensions 141,illustrated in FIG. 22A. This action also moves the underlying fixed waydirection setting plate 136 from the position illustrated in FIG. 38 tothe position illustrated in FIG. 39, where the case boss 102C, providedon the underlying case 102, extends over the entrance stop 137C in thefixed way direction setting plate 136 and registers with the adjacentcorresponding detent 137A. This movement of the fixed way directionsetting plate 136 is effected by contact between the end of the shorterdrive direction setting plate 134 and the corresponding boss 136A,located on the fixed way direction setting plate 136. This contactforces the fixed way direction setting plate 136 in the direction of thearrow illustrated in FIGS. 37 and 38 to effect registration of the caseboss 102D on the case 102 in the detent 137A located in the fixed waydirection setting plate 136. Accordingly, when the crescent 101 is inthis position, the needle 50 is constrained to increment in theclockwise direction responsive to pressing of the trigger 1267 andoperation of the reciprocation input collar 1216, as described above,with respect to FIG. 55, since the reciprocating driver 108 is now inthe drive position on the drive direction setting plate 134. This driveposition is effected by the bias in the direction mount-to-drive mountspring 1215A (FIG. 65) which pulls the drive cable 1247, along with thedirection cable 1248 and seats the reciprocating driver 108 in driveconfiguration in the case 102 when the drive direction setting plate 134and the fixed way direction setting plate 136 are in position asdescribed above, for counterclockwise rotation of the needle 50.

In one mode, the needle 50 is constrained to move in thecounterclockwise direction around the crescent 101, since movablelocking of the fixed way direction setting plate 136 on the case 102 asillustrated in FIG. 21 bends the respective leaf tensioning tabs 118 andlonger tabs 118A of the driver blades 112 in the driver 108, such thatthe forwardly-inclining driver blades 112B engage the needle 50, asillustrated in FIG. 8A of the drawings. Furthermore, since therespective sets of the driver blades 112 all extend downwardly throughthe parallelogram-shaped openings in the reciprocating driver 108 intothe drive direction setting plate 134, subsequent rotation of thereciprocating driver 108 responsive to trigger tensioning of the loopeddrive cable 1247 effects rotation of the reciprocating driver 108, theneedle 50 and the drive direction setting plate 134 in concert withrespect to the overlying fixed way 104 and underlying fixed waydirection setting plate 136 and the case 102, the latter three of whichremain immobile. This advancement of the needle 50 in thecounterclockwise direction around the crescent 101 continues withforward and reverse incrementation of the reciprocating driver 108 andthe drive direction setting plate 134 until the needle direction settingmechanism is changed by again manipulating the direction actuator 1214opposite to the position illustrated in FIG. 65, as illustrated in FIG.67. This action causes a shift in the fixed way direction setting plate136 in the opposite direction on the case 102, along with thereciprocating driver 108, by operation of the drive direction settingplate 134, as heretofore described. This shift causes a different set ofdriver blades 112 (rearwardly-inclining driver blades 112C) to engagethe needle 50 and force the needle 50 in the opposite (clockwise)direction responsive to traversal of the reciprocating driver 108 andthe drive direction setting plate 134 around the case 102, asillustrated in FIGS. 8B and 24-29.

Referring now to FIG. 81 of the drawings as the needle 50 traverses thecrescent 101 in the counterclockwise direction the thread 50 is pulledthrough the tunnel 100A from the entrance 100B to the exit 100C, asillustrated. In a preferred embodiment of the invention it is desirableto mount a thread incrementing accessory 1101 on at least one end of thecrescent 101, typically on the receiving arm 101B, to create a loop inthe thread head 50D of the thread 50A during the suturing operation, andprovide additional slack for another rotation of the needle 50 throughthe material 100. Furthermore, a sliding hook 50E, also illustrated inFIG. 81, may be used to manually position the thread head 50D loop andin the alternative, a hook/unhook device 1000 can be utilized for thesame purpose, as illustrated in FIG. 98 and as hereinafter furtherdescribed. Accordingly, with the thread incrementing accessory 1101mounted on the receiving arm 101B of the crescent 101, the size of thethread head 50D loop in the thread 50A is controlled by operation of thethread incrementing accessory 1101 as hereinafter described.

Referring now to FIGS. 80, 81, 84, 87, 88 and 97 of the drawings afterthe needle 50 has made an initial traversal through the material 100 oftissue to be sutured as illustrated, the fixed blades 1114 of the threadincrementing accessory 1101 initially engage the thread 50A as theneedle 50 pulls the thread around the crescent 101. The threadincrementing accessory 1101 is then operated as hereinafter described tomove the movable housing 1115 rearwardly away from the material 100 withrespect to the fixed housing 1120 and bend the tabs 1118 and longer tabs1118A of the corresponding higher movable blades 1112 and movable blades1113 to engage the higher movable blades 1112 and movable blades 1113with the thread 50A extending through the guide slot 1126A of themovable housing 1115, as illustrated in FIG. 84. Continued rearwardmovement of the movable housing 1115 with respect to the fixed housing1120 on the advancing arm 101B of the crescent 101 pulls the thread 50Athrough the tunnel 100A and from the exit 100C from the positionillustrated in FIGS. 80 and 88 and incrementally, to the positionillustrated in FIG. 81, thus forming a loop of desired size in thethread head 50D of the thread 50A. Control of this loop is typicallyeffected by the action of the sliding hook 50E in FIG. 81 or of ahook/unhook device 1000 (illustrated in FIG. 98 of the drawings), asheretofore described. Additional rotations of the needle 50 to createadditional tunnels 100A in the material 100 can be effected due to thisslack in the thread head 50D of the thread 50A and in each case thethread incrementing accessory 1101 can be operated as described above tocreate this slack.

Referring now to FIGS. 81-83 of the drawings when the thread head 50D ofthe thread 50A is formed into a loop as illustrated in FIGS. 81 and 82using the thread incrementing accessory 1101, a suture loop can beshaped in the thread 50A to begin a suture by extending the free end ofthe thread tail 50C around the thread head 50D forwardly of the threadincrementing accessory 1101, as illustrated in FIG. 82. Furthermore, asillustrated in FIG. 83, two segments of the material 100 can be joinedtogether with a suture by entwining the thread 50A, which extendsthrough adjacent segments of the material 100, as illustrated. Thisentwinement 50G is effected by first tightening the first loopillustrated in FIG. 82 and effecting a second loop to define a squareknot or entwinement 50G in the thread 50A by again looping the threadtail 50C around the thread head 50D.

As further illustrated in FIG. 89 an additional thread incrementingaccessory 110A can be utilized in the crescent 101 by mounting theadditional thread incrementing accessory 1101A on the advancing arm101A, as illustrated. Both the thread incrementing accessory 1101 andthe additional thread incrementing accessory 1101A can then be operatedas described above to create loops in the thread 50A between thematerial 100 and the thread incrementing accessory 1101 and theadditional thread incrementing accessory 1101A, respectively, tofacilitate tying of knots or entwinements 50G to create the desiredsutures as illustrated in FIGS. 80-83 of the drawings.

Referring now to FIGS. 4, 84, 87, 90 and 90C-91 of the drawings thethread incrementing accessory 1101 is typically operated by depressingthe trigger 1261B on the second handle 1261 as illustrated in FIG. 4 toeffect incremental extension and retraction of the power transmissionwire 1140 extending through the flexible tube 1141, and move theactuation plate 1134 and the movable housing 1115 back and forth on thecase 102 with respect to the fixed housing 1120, on the receiving arm101B as illustrated in FIGS. 90A-90C. The forward movement opens thehigher movable blades 1112 and the movable blades 1113 by releasingpressure on these blades due to release of contact between the actuationplate 1134 and the tabs 1118, the longer tabs 1118A of the highermovable blades 1112 and the movable blades 1113, respectively. Thisoccurs by sliding operation of the actuation plate 1134 from the neutralposition illustrated in FIG. 90A, into the normal range of motion 1144Cand then into the extended range of motion 1144D (FIG. 90B). Since theactuation plate 1134 is fitted with four parallelogram holes 1138 forreceiving the extending ends of the tabs 1118 and longer tabs 1118A ofthe higher movable blades 1112 and the movable blades 1113, and sincethese tabs 1118 and longer tabs 118A extend from the movable housing1115 through corresponding and aligned clearance holes 1124 in themovable housing 1115, pressure is brought to bear on the extending endsof the tabs 1118 and the longer tabs 1118A responsive to rearwardsliding movement of the actuation plate 1134 (FIG. 90C). And, asheretofore described, this sliding movement of the actuation plate 1134and the movable housing 1115 on the case 102 in both directions in thenormal range of motion 1144C is accomplished by selectively extendingand retracting the power transmission wire 1140 in the flexible tube1141 responsive to depression of the trigger 1261B on the second handle1261, as illustrated in FIG. 4. Accordingly, opening of the respectivemovable blades 1113 and fixed blades 1114 and removing these blades fromcontact with that portion of the thread 50A which lies within the guideslot 1126A of the movable housing 1115 is effected by forcing theactuation plate 1134 forwardly to move the movable housing 1115forwardly in the fixed housing 1120 (FIG. 90B), as the powertransmission wire 1140 is extended in the flexible tube 1141. Thisaction allows the movable housing 1115 to extend to its farthest distalextension into the extended range of motion 1144D the fixed housing1120, such that the movable blades 1113 and the fixed blades 1114 arenot contacting the thread 50A. The movable blades 1113 and fixed blades1114 are then caused to engage the thread 50A by reversing movement ofthe power transmission wire 1140 and moving the movable housing 1115back to the proximal position rearwardly in the fixed housing 1120 (FIG.90C), which action bends the corresponding tabs 1118 and the longer tabs1118A rearwardly and causes opposite rows of these blades to extendinwardly toward each other, engage the thread 50A and pull the thread50A from the material 100, as illustrated in FIG. 82. Additionalincremental movements of the movable housing 1115 in the sequence offirst disengaging the movable blades 1113 and the fixed blades 1114 fromthe thread 50A and then engaging the thread 50A with the movable blades1113 and fixed blades 1114 responsive to forward and rearward movementof the actuation plate 1134 and the movable housing 1115, respectively,(FIGS. 90B and 90C), facilitates extension of the thread head 50D of thethread 50A as illustrated in FIG. 82 into a sufficiently large loop toallow additional rotation of the needle 50 through the material 100, aswell as defining and tightening the sutures in the thread 50A, asillustrated in FIG. 83. The fixed blades 1114 remain in place on thefixed housing 1120 to maintain the thread 50A in the guide slot 1126A ofthe thread incrementing accessory 1101 during this sliding action of themovable housing 1115. When it is desired to remove the thread 50A fromthe thread incrementing accessory 1101 without cutting the thread 50A,the actuation plate 1134 is pushed forward (distally) in the access slot1144A and the narrowing slot 1144B, illustrated in FIG. 91, to open thehigher movable blades 1112 and movable blades 1113 and remove theseblades from contact with the thread 50A. Further forcing of theactuation plate 1134 forwardly by pressure on the power transmissionwire 1140 forces the housing walls 1120D of the fixed housing 1120 apartat the hinge 1121 A (FIGS. 84, 90B and 91), as the access extension tab1144, attached to the activation plate 1134, is forced into thenarrowing slot 1144B (FIG. 91), which action also forces the fixedblades 1114 apart to release the thread 50A from the thread incrementingaccessory 1101.

Under circumstances where an additional thread incrementing accessory1101A is attached to the crescent arm 101A of the crescent 101 asillustrated in FIG. 89, the additional thread incrementing accessory1101A can be attached to the trigger 1261B and the second handle 1261 byan additional flexible tube 1141 and power transmission wire 1140 (notillustrated) to operate both the thread incrementing accessory 1101 andthe additional thread incrementing accessory 110A simultaneously.

Referring again to FIGS. 98-108 of the drawings the hook/unhook device1000 and the double installation version 1000A of the hook/unhook device1000 are used to manipulate the thread 50A and facilitate tying of knotsor sutures, as follows. As illustrated in FIG. 108 the hook/unhookdevice 1000, when used alone and in the double installation version1000A, is characterized by a housing tube 1040 and an auxiliary housingtube 1040A (FIG. 106), each of which encloses an inner housing tube1045, which extends from the front end of the housing tube 1040 and theauxiliary housing tube 1040A at a housing tube enlarged section 1042,respectively. Each inner housing tube 1045 also extends rearwardly fromthe corresponding housing tube 1040 and the auxiliary housing tube1040A, respectively, to receive a pair of three-position switch bodies1058C, attached to the respective inner housing tubes 1045, as well as acenter-located, three-position switch actuator 1058D, secured to theactuation wire 1050 extending through the housing tube 1040 and theauxiliary housing tube 1040A, respectively, as heretofore described.Accordingly, sliding manipulation of the three-position actuator 1058Dto reciprocate the actuation wire 1050 and thus, the grip/eject/cutblade 1020 inside the inner housing tube 1045, is illustrated in FIG.102. As further heretofore described, the crescent attachment mountpoint 1058 is attached to the crescent 101 by any convenient means, suchas screws or welding, in non-exclusive particular, while the tubularattachment mount point 1058A is secured to the second handle 1261,illustrated in FIG. 4 of the drawings.

Referring now to FIGS. 98 and 104-106 of the drawings the respectiveinner housing tube 1045 of the hook/unhook device 1000 individually, andin the double installation version 1000A, is manipulated to receive thethread tail 50C of the thread 50A in the hook open profile 1018, asillustrated in FIG. 102A, responsive to extension of the actuation wire1050 and the attached grip/eject/cut blade 1020 in the inner housingtube 1045, respectively. This action creates the hook open profile 1018to accommodate a segment of the thread tail 50C, as illustrated in FIGS.102A and 105. In like manner, the second hook/unhook device 1000 can bemanipulated such that second grip/eject/cut blade 1020 also defines ahook open profile 1018 for receiving a segment of the thread head 50D.Manipulation of the thread 50A into the loosely knotted positionillustrated in FIG. 104 is then typically effected by forward andreverse operation of the respective hook/unhook devices 1000 in thedouble installation version 1000A to tighten the knot or sutures orentwinements 50G, as illustrated in FIG. 105. The knot or entwinement50G can be further tightened by further extension of one of thehook/unhook devices 1000 in the double installation version 1000A andreverse operation of the companion hook/unhook device 1000, as furtherillustrated in FIG. 106. Referring to FIGS. 102, 107 and 108 the pullingof the thread 50A through the material 100 to produce a relief loop 50Brequires hooking the thread head 50D in first, a sliding hook actionusing hook faces 1012 then pulling the thread 50A into housing tube'senlarged section 1042 until a large enough loop has been drawn throughthe material 100. When this has been done the inner housing tube 1045and hook 1010 are pushed back out of tube section 1042. Plunger disk1065 ejects the loop 50B from the tube section 1042 allowing it toexpand away from the device 101.

Accordingly, it will be appreciated from a consideration of FIGS. 98 and104-108 that the hook/unhook device 1000 and particularly, the doubleinstallation version 1000A, which incorporates two of the hook/unhookdevices 1000, can be utilized to manipulate various segments, includingthe thread tail 50C and the relief loop 50B, as well as the head portion50D of the thread 50A, both outwardly and inwardly, into the housingtube 1040 to remove the thread loop from the area of operation andcreate the sutures or entwinements 50G illustrated in FIGS. 105 and 106.The thread loop can then be pushed from the housing tube 1040 by theplunger disc 1065 (FIG. 108). This manipulation is effected by separateslidable movement of the respective three-position switch actuator 1058Dlocated between the corresponding pair of parallel three-position switchbodies 1058C, either by itself or in concert with the three-positionswitch bodies 1050C, as illustrated in FIG. 108.

It will be appreciated from a consideration of the drawings and theabove description that the dual-direction embodiment of the cyclingsuturing and knot-tying device of this invention is characterized bygreat flexibility, utility and ease of operation, in that it can bequickly and easily positioned by an operator for rapid, accurate andconvenient suturing of incisions and wounds, as well as suturing oforgans and other tissue located inside these incisions. The elongatedtransmission tube 1200 is tapered at the arcuate crescent end to definean extension tube that terminates in a ball and socket-mounted,universally rotatable, arcuate crescent of selected size, fitted with anarcuate needle that traverses the crescent in either direction,depending upon the setting of a slide switch positioned on thetransmission tube. The transmission tube is also mounted on a cradle,pivoted on a handle, for both rotatable and pivotal manipulation of thetransmission tube to further position the crescent in a preciselydetermined location. The crescent itself can be easily manipulated onthe end of the extension tube into a variety of positions by operationof a lever located at the handle, or operating end of the transmissiontube. The curved needle is driven selectively in either the clockwise orcounterclockwise direction in the crescent using a system of variousnumbers of blade housings and blades that are harder than the needle, bydepression of a trigger located in the handle for easy control ofsutures placed in the tissue. Furthermore, one or more threadincrementing accessory can be placed on one or both ends of the crescentto optimize creation of a loop in the thread for additional needlerotation and to further facilitate knotting or tying or suturing thethread, typically with the help of one or more hook/unhook devices whichmay be separately manipulated by the operator to articulate the threadinto entwinements, knots and sutures in the tissue.

Referring to FIGS. 109-112D of the drawings in a preferred embodiment ofthe cycling suturing and knot-tying device of this invention aunidirectional device is generally illustrated by reference numeral 1A.As illustrated in FIGS. 109 and 109A the unidirectional device 1A ischaracterized by an arcuate fixed way/case 2, mounted on a socket 775AAand characterized by four, equally-spaced way/case blade housing bosses11, provided in the walls of the fixed way/case 2 and fitted withseveral sets of fixed way blades 12E. The fixed way blades 12E arearranged in an oppositely-disposed configuration defining a chevronpattern pointing in the direction of travel of an arcuate needle 50,which seats in the fixed way/case 2 as further illustrated in FIG. 109.Four sets of 16 flexible fixed way blades 12E, arranged inoppositely-disposed sets of 8, are typically provided in each of theweigh/case blade housing bosses 11. Each of the fixed way blades 12E ispreferably characterized by an arcuate concave contact profile 17 forsecurely engaging the cross-sectionally round needle 50, which concavecontact profile 17 extends upwardly to define a top rounded end 19 anddownwardly to define a bottom rounded end 19A, as illustrated in FIGS.109D and 109E. A blade floor clearance 23 is provided between the bottomedges of each of the fixed way blades 12E and the floor of the needleguide slot 26 of the fixed way/case 2, for purposes which will behereinafter described. The distances between the respective way/caseblade housing bosses 11 in the fixed way/case 2 define respective opennotches 6 in the needle guide slot 26 to facilitate movement of therespective driver housing bosses 10, spaced-apart on an arcuateconnection member 9, to define a reciprocal driver 8 that seats in thefixed way/case 2, as further illustrated in FIGS. 109 and 109A. Each ofthe driver housing bosses 10 is further characterized by a set ofchevron-shaped driver blades 12D which are harder than the needle 50 andare oriented in the direction of travel of the needle 50 and designed toengage the needle 50 for driving the needle 50 forwardly through thefixed way/case 2 by driving mechanisms hereinafter further described. Ina preferred embodiment of the invention each of the driver housingbosses 10 contains 16, spaced-apart driver blades 12D, arranged inoppositely-disposed sets of 8, each provided with the same chevron shapeand contour pattern as the fixed way blades 12E illustrated in FIGS.109D and 109E of the drawings. Accordingly, it will be appreciated froma consideration of FIG. 109 that the needle 50 is designed to seatsimultaneously in all three of the driver housing bosses 10 and in allfour of the way/case blade housing bosses 11 when the needle 50 isinserted in the position illustrated in FIG. 109. A length of thread 50Aextends from one end of the needle 50 and the needle gap 105A, measuredbetween the sharpened needle tip and the point where the thread isattached to the opposite end of the needle 50, and essentiallycorresponds to the gap 5 measured between the respective ends of thecurved advancing arm 2A and receiving arm 2B of the fixed way/case 2.Both the fixed way blades 12E and the driver blades 12D can be securedin the fixed way/case 2 by means of slots (not illustrated) or the fixedway blades 12E and the driver blades 12D may be molded or otherwiseconstructed from a single piece of material that defines each of theway/case blade housing bosses 11 and the driver housing bosses 10,respectively, as illustrated in FIGS. 109D and 109E. Furthermore, thematerial of construction used in the driver housing bosses 10 and theway/case blade housing bosses 11 may vary, depending upon the needlemount desired and may include a stiff plastic, metal, fiberglass or thelike, which is sufficiently strong to ensure the integrity of the bladesand which offers sufficient blade resiliency to facilitate easy passageof the needle 50 through the respective blades and retarding of reversemovement of the needle during incrementation of the driving mechanism.

Referring again to FIGS. 109 and 109A of the drawings it will beappreciated that the reciprocal driver 8 is seated in the fixed way/case2 in the manner illustrated in FIG. 109 such that each of the driverhousing bosses 10 is free to increment in the clockwise andcounterclockwise direction with respect to the fixed way/case 2throughout the length of the corresponding notches 6. Accordingly, itwill be further appreciated by those skilled in the art that the numberof driver housing bosses 10 can be varied on the connection member 9 andadditional or fewer way/case blade housing bosses 11 can be provided, tofacilitate a longer or shorter reciprocating incrementation between therespective driver housing bosses 10 and the corresponding way/case bladehousing bosses 11 in the respective notches 6 of the fixed way/case 2.Various numbers of the driver housing bosses 10 and the way/case bladehousing bosses 11 may be necessary to facilitate suturing thin, lessdense tissue on the one hand, and also thick, sinewy, dense tissue whichrequires more pressure on the needle 50 and therefore better gripping ofthe needle 50 by the respective driver blades 12D in the driver housingbosses 10, respectively. It will be further appreciated from aconsideration of FIGS. 109, 109D and 109E of the drawings that therespective driver blades 12D and fixed way blades 12E are angled in theneedle guide slot 26 such that the blades are slightly bent when theneedle 50 is installed, yet forward movement of the needle 50 betweenthe respective driver blades 12D and fixed way blades 12E meets withlittle resistance, whereas rearward movement of the needle 50 meets withsignificant resistance that increases with the applied force in therearward direction.

Referring now to FIGS. 109A-109C, 109F-109H and 1091 of the drawings ina preferred aspect of this embodiment of the invention the drivingmechanism for the reciprocal driver 8—is characterized by a curved,beveled rack 48, having a rack access rib 48G fixed to the connectionmember 9, typically located beneath the center one of the driver housingbosses 10. When the unidirectional device 1 is assembled as illustratedin FIG. 109 the rack access rib 48G of the beveled rack 48 is designedto extend through a curved rack slot 48C, provided in the needle guideslot 26 of the fixed way/case 2, as illustrated in FIGS. 109A and 109D.This facility allows the rack teeth 48L provided on the beveled rack 48to engage corresponding gear teeth 48K provided on a beveled pinion gear48A, as illustrated in FIG. 109C. In a first preferred embodiment ofthis aspect of the drive mechanism the beveled pinion gear 48A ischaracterized by a continuous set of gear teeth 48K extending around theentire beveled surface area of the beveled pinion gear 48A, to receivepower applied to a flexible pinion gear shaft 48H, which extends througha corresponding flexible housing tube 49 to a conventional drive, suchas a conventional micromotor 48B, illustrated in FIG. 109A. Operation ofthe conventional micromotor 48B effects incrementation of the beveledrack 48 and thus, the driver housing bosses 10 of the reciprocal driver8, in the corresponding notches 6 of the fixed way/case 2. Since theconventional micromotor 48B is reversible, this incrementation of thereciprocal driver 8 can be implemented in both directions, such that therespective driver housing bosses 10 may be selectively manipulated inthe clockwise and the counterclockwise direction in the notches 6, byforward or reverse operation of the conventional micromotor 48B. Thisaction facilitates movement of the needle 50 in the forward, typicallycounterclockwise direction as illustrated in FIG. 109, responsive todriving of the beveled pinion gear 48 in the counterclockwise directionas viewed in FIG. 109C, to force the beveled rack 48A in the samedirection. Reverse incrementation of the reciprocal driver 8 occurs whenthe conventional micromotor 48B is reversed, to change the direction ofrotation of the beveled pinion gear 48A and thus, the direction oftravel of the beveled rack 48, to return the reciprocal driver 8, butnot the needle 50, to the original driving position, as hereinafterfurther described.

In another embodiment of this aspect of the invention the gear teeth 48Karranged on the beveled portion of the beveled pinion gear 48A arediscontinuous at a flattened rack return segment 48D, as illustrated inFIG. 109B to facilitate automatic return of the reciprocal driver 8 toan original incrementing position as the flattened rack return segment48D rotates into facing relationship with respect to the rack teeth 48Lon the beveled rack 48. This action occurs in the mechanical arrangementillustrated in FIG. 109 I, wherein a return spring 48E extends betweenthe rack access rib 48G of the bevel rack 48 and a fixed return springmount 48F attached to the bottom of the fixed way/case 2. Accordingly,when the flattened rack return segment 48D approaches the rack teeth 48Lof the beveled rack 48 and the gear teeth 48K disengage the rack teeth48L, the beveled rack 48 is caused to return to its original position inthe rack slot 48C by operation of the bias in the return spring 48E andautomatically re-increment the reciprocal driver 8 back into itsoriginal driving position.

In still another embodiment of this aspect of the invention a pair ofcurved access extension slots 41 may be provided in the bottom of theneedle guide slot 26 between opposite respective pairs of the way/caseblade housing bosses 11, as illustrated in FIG. 110 and a drive cableextension 40 is provided on each end of the reciprocal driver 8 beneatha corresponding driver housing boss 10, as illustrated in FIGS. 110,110A, and 110B. Each drive cable extension 40 is extended through acorresponding one of the access extension slots 41 (FIG. 110) to projectbeneath the fixed way/case 2 for sliding disposition in the respectiveaccess extension slots 41 and receiving one end of a pair of drivecables (typically drive cables 1247 illustrated in FIGS. 56 and 57 ofthe drawings). The opposite ends of these control cables are typicallyconnected to a driving apparatus such as the reciprocation input collar1216 in input section 1200C and the transmission tube 1200, as furtherillustrated in FIGS. 56 and 57 to facilitate selective incrementation ofthe reciprocal driver 8 in both the clockwise and counterclockwisedirections and incrementally drive the needle 50 around the fixedway/case 2 in a direction determined by the orientation of the needle 50in the fixed way/case 2, by manipulation of the cables responsive tooperation of the drive mechanism in the transmission tube 1200 oralternative operator.

In another embodiment of the cycling, suturing and knot-tying device ofthis invention the advancing arm 2A of an alternate unidirectionaldevice 1B is illustrated in FIGS. 112 and 112A, wherein an alternatefixed way 15A insert is provided in place of the way/case blade housingbosses 11, and is constructed of a resilient material such as plastic ofsuitable composition, designed to receive a pair of oppositely-disposed,forwardly-angled fixed way blades 15GX, as illustrated. The alternatefixed way 15A is inserted or seated in an alternate fixed way case 15such that the locking bosses 15B in each end of the alternate fixed waycase 15 engage corresponding lock notches 15C in the alternate fixed way15A, to prevent sliding of the alternate fixed way 15A in the alternatefixed way case 15. In a preferred aspect of this embodiment each of thefixed way blades 15GX is seated in a resilient fixed way blade holder15XX in the alternate fixed way 15A and is provided with an enlargedfixed way blade bearing boss 15HX on one end, which seats in acorresponding fixed way bearing hole 15DX, that curves to define anarrow bearing hole opening or neck 15PX. Accordingly, each fixed wayblade 15GX is allowed to pivot with the respective driver bearing boss15HX in the bearing hole opening or neck 15PX as the opposite end of thefixed way blade 15GX contacts the needle 50. The angle of orientation ofeach of the fixed way blades 15GX in the alternate fixed way 15A is suchthat the needle 50 is able to move forwardly in the alternate fixed waycase 15 in the direction of the forward direction arrow 15L asillustrated in FIGS. 112 and 112A, but cannot move rearwardly in thedirection of the resistance force arrow 15Q, as further illustrated inFIGS. 112 and 112A. Each of the fixed way driver blades 15GX extendsfrom the bearing hole opening or neck 15PX, through a shaped springexpansion relief void 15MX before contacting the needle 50, as furtherillustrated in FIGS. 112 and 112A. Furthermore, positioned along thelength of the spring expansion relief voids 15MX on each side of thefixed way blades 15GX, are fixed way spring membranes 15EX, each ofwhich borders a fixed way spring cavity 15FX. Each of the fixed wayspring membranes 15EX are constructed of a resilient material such as athin wall of plastic, to facilitate flattening of the fixed way springmembranes 15EX into the respective adjacent fixed way spring cavities15FX, as pressure is brought to bear on the corresponding fixed wayblades 15GX by movement of the needle 50 in the counterclockwisedirection through the alternate fixed way case 15 of the alternateunidirectional device 1A. Accordingly, the oppositely-disposed fixed wayspring membranes 15EX serve as shock absorbers and tensioning members,acting on the respective fixed way blades 15GX, to prevent the needle 50from undesirable rearward movement in the direction of the resistanceforce arrow 15Q and to facilitate easier forward movement of the arrow50 in the direction of the forward direction arrow 15L, as furtherillustrated in FIGS. 112 and 112A.

In like manner, as further illustrated in FIGS. 112 and 112A, thealternate driver 7 is configured in generally the same shape as thereciprocal driver 8 and is fitted inside the alternate fixed way case 15and the alternate fixed way 15A in the alternate unidirectional device1B. The alternate driver 7 includes at least one pair ofoppositely-disposed, forwardly-oriented driver blades 15G, each havingan enlarged driver bearing boss 15H at the base thereof and seated in acorresponding driver bearing hole 15D in a resilient driver blade holder15X. Accordingly, a driver blade holder 15X is provided in each of thethree driver housing bosses 10, illustrated in FIGS. 109 and 109A. Theopposite end of each of the respective driver blades 15G is shaped toengage the needle 50 as indicated in FIGS. 112 and 112A and the driverblades 15G are able to flex forwardly and rearwardly with movement ofthe needle 50, due to contact with the driver bearing hole opening 15Rand the oppositely-disposed driver spring membranes 15E, borderingcorresponding driver spring cavities 15F, shaped to extend into each ofthe corresponding shaped driver relief voids 15M. Accordingly, it willbe appreciated from a consideration of FIGS. 112 and 112A that themechanism for facilitating movement of the driver blades 15G withrespect to movement of the needle 50 is the same as the mechanism foreffecting movement of the fixed way blades 15GX in the fixed way bladeholders 15XX, with corresponding movement of the needle 50. In bothcases, the respective driver blades 15G and fixed way blades 15GXfacilitate movement of the needle 50 in the direction of the forwarddirection arrow 15L, but retard reverse movement of the needle in thedirection of the blade resistance arrows 15KX and the resistant forcearrow 15Q, as illustrated in FIG. 112 and described above. A pair ofangled entry guides 27A are also provided on the fixed way blade holders15XX, respectively, for guiding the end of the needle 50 into thereceiving arm 2B of the alternate fixed way case 15, as illustrated inFIG. 12A.

An advantage of the embodiment and means of controlling the swing of therespective fixed way blades 15GX and the driver blades 15G illustratedin FIGS. 112 and 112A is that thicker blade material can be used and itis therefore possible to use fewer blades without lowering theresistance capability of the blades to rearward movement of the needle50. Furthermore, a precise positioning of each of the fixed way blades15GX and driver blades 15G, respectively, in relationship to the needle50, is facilitated.

In yet another embodiment of this aspect of the invention where thealternate unidirectional device 1B and an alternate resilient fixed way15A is utilized, a pair of alternative fixed way blades 15GGG, eachhaving an alternate fixed way blade retention boss 15HHH are mounted inoppositely-disposed relationship in a pair of resilient alternate fixedway retaining supports 15SS, projecting into the corresponding fixed waystructural cavities 15000 (FIG. 112B). The respective alternate fixedway blade retention bosses 15HHH seat the corresponding alternate fixedway blades 15GGG in place in a corresponding alternate fixed way bladeretaining cavity 15VVV, all in the alternate fixed way 15A. Thealternate fixed way blade mounting structure 15TT tapers rearwardly ofthe parallel alternate fixed way blade retaining supports 15SSS todefine an alternate blade mount flexible connector 15UU that lendsadditional flexibility and yet resiliency, to the alternate fixed wayblade mounting structure 15TT and the fixed way blades 15 GGGthemselves. Similarly, the alternate driver blades 15GG in the resilientdriver blade mounting structure 15T of the second alternate driver 7Acan be mounted in corresponding driver blade retaining supports 15S,that extend into the corresponding driver structural cavities 1500, andtaper to define a driver blade mount flexible connector 15U. Thismounting structure lends flexibility yet resiliency, to the movement ofthe alternate fixed way driver blades 15GG, responsive to forwardmovement of the needle 50 in the direction of the forward directionarrow 15L. The structure also facilitates driver blade resistance to thetendency for rearward movement of the needle 50 in the direction of theresistance force arrow 15Q, as further illustrated in FIG. 112B. A pairof alternate angled entry guides 27 are also provided in the ends of therespective alternate fixed way 15A, for guiding the needle 50 into thereceiving arm 2B of the alternate fixed way 15A, as illustrated in FIG.112C. As further illustrated in FIG. 112 D, in a preferred aspect ofthis embodiment of the invention the needle-engaging ends of thealternate driver blades 15GG, as well as the alternate fixed way blades15GGG, the fixed way blades 15GX and the driver blades 15G, are providedwith a serrated area 15N to facilitate additional security in therespective blade engagement with the needle 50.

Referring now to FIGS. 109, 109A, 111-111C of the drawings, undercircumstances where any of the driver mechanisms (not illustrated)described above are operated to effect movement of the needle 50 aroundthe fixed way/case 2, (as well as the alternate fixed way case 15) theneedle 50 is initially driven in the counterclockwise direction from theposition illustrated in FIGS. 109 and 111 to the position illustrated inFIG. 111A and through material to be sutured 100, which is positioned inthe opening or gap 5 (FIG. 109) spanning the advancing arm 2A and thereceiving arm 2B of the unidirectional device 1A (or the alternateunidirectional device 1B, not illustrated). As the blade 50 enters thematerial 100 as illustrated in FIG. 111A the reciprocal driver 8 (or thealternate driver 7 or second alternate driver 7A) is incremented insidethe needle guide slot 26 with each of the respective driver housingbosses 10 traversing the respective notches 6 lying adjacent tocorresponding way/case blade housing bosses 11 (FIG. 109A). Therespective driver blades 12D thus engage the needle 50 in drivingrelationship. At this point, the driving mechanism is reversed toreverse the reciprocal driver 8, or the alternate driver 7, or thesecond alternate driver 7A, (not illustrated) and re-increment thereciprocal driver 8 or the other drivers from the position illustratedin FIG. 111A back to the position illustrated in FIG. 109. This actionleaves the needle 50 in the position as illustrated in FIG. 11A, due tothe forward positioning of the respective driver blades 12D and fixedway blades 12E, that prevent reverse-rotation of the needle 50. When thereciprocal driver 8 (or the alternate driver 7 or the second alternatedriver 7A) is re-incremented by the driving mechanism into driving mode,illustrated in FIG. 109, those driver blades 12D (or the driver blades15G or the alternate driver blades 15GGG) contacting the needle 50 againgrip the needle 50 and cause the needle 50 to increment forwardly intothe position illustrated in FIG. 111B. The reciprocal driver 8, as wellas the alternate driver 7 or the second alternate driver 7A are then inthe position illustrated in FIG. 111B, but with the needle 50 furtherincremented through the material 100 and re-entering the receiving arm2B of the unidirectional device 1. At this point, the reciprocal driver8 (or the alternative drivers) are then again re-incremented into theposition illustrated in FIG. 109, where the driver blades 12D (or theother driver blades described above) contacting the needle 50 againgrasp the needle 50 and force it around the needle guide slot 26 in thefixed way/case 2 to the position illustrated in FIG. 111C, where itapproaches a complete rotation through the unidirectional device 1, withthe thread 50A (illustrated in phantom) also in position for pullingthrough the material 100 as the needle 50 further increments around theneedle guide slot 26 and across the gap 5 (FIG. 109) of theunidirectional device 1.

It will be appreciated by those skilled in the art that theunidirectional devices 1A and 1B embodiment of the invention ischaracterized by flexibility and simplicity of use since the drivingmechanism device can be varied, as heretofore described. In one case,referring again to the drawings, the beveled pinion gear 48A may operatea curved, beveled rack 48 to increment the reciprocal driver 8 in themanner heretofore described and the beveled pinion gear 48A can beselectively operated in forward and reverse mode to effect the desiredincrementation. In another embodiment the beveled pinion gear 48A can beprovided with a flattened rack return segment 48D where the gear teeth48K are not continuous, to facilitate automatic reversal of the beveledrack 48 by action of the return spring 48E. In yet another embodimentthe reciprocal drive operation can be provided with downwardly-extendingdrive cable extensions 40 for receiving the ends of cables (notillustrated) that project to an incrementing driving mechanism (notillustrated) for effecting the desired incrementation of the driver,causing the needle 50 to traverse the device. Furthermore, therespective blades, which are in all cases harder than the needle 50, canbe mounted in a variety of ways in both the fixed way/case 2 and therespective drivers in the both unidirectional device 1A and alternateunidirectional device 1B to facilitate easy movement of the needle 50 ina chosen direction for suturing, and yet retard rearward movement of theneedle 50 responsive to reverse incrementation of the respectivedrivers.

Referring now to FIGS. 113-138 of the drawings in another embodiment ofthe cycling suturing and knot-tying device a forked blade device 201 isillustrated for incrementing an arcuate needle 50 in an arcuate fixedway 240 that is typically snapped into an arcuate case 210 over ahousing 220 and a driver 230, for manipulating multiple forked blades225, simpler forked blades 226 or alternative blades 227, seated in thehousing 220. The case 210 is provided with a gap 205 that spans thedistance between the facing ends of the case 210 and is approximatelycoextensive with the needle gap 105A extending between the pointed endsof the needle 50, as illustrated in FIG. 113. Referring to FIG. 114 ofthe drawings the case 210 is fitted with a pair of spaced-apart, curvedlocking slots 210E, each having a wider section 210F and a narrowsection 210J, which wider sections 210F are disposed at opposite ends ofthe locking slots 210E, for purposes of access, as hereinafterdescribed.

As illustrated in FIG. 115 of the drawings the case 210 is furthercharacterized by an arcuate track 210A, bounded by an inner wall 210Band an outer wall 210C, with the arcuate locking slots 210E extendingthrough the case floor 210D. As further illustrated in FIGS. 114 and 116a socket 775 is attached to the case 210 opposite the gap 205 and a leftclearance tunnel 775A and a right clearance tunnel 775B are provided inthe socket 775 to facilitate entry of a pair of device cables 1247 anddirection cables 1248 for control purposes, as illustrated in FIG. 114and as further hereinafter described.

Referring to FIGS. 117 and 117A of the drawings an arcuate driver isgenerally illustrated by reference numeral 230 and includes a pair ofdownwardly-extending driver tabs 230D, each having a driver tabextension 230L and a driver tab weld attachment groove 230M, provided onthe driver tab extension 230L. The driver tab weld attachment grooves230M are designed to receive one end of the pair of drive cables 1247,illustrated in FIG. 114 and illustrated in phantom in FIG. 117A, forwelding the control cables to the respective driver tab extensions 230Lat the weld beads 230P and controlling incrementation of the driver 230throughout the length of the respective locking slots 210E, ashereinafter further described. Three sets of bearing slots 230A are alsoprovided in the driver 230 and corresponding, oppositely-disposedbearing slot walls 230G project into the bearing slots 230A forpivotally receiving the lever 225D in each of the forked blades 225 (notillustrated), as further hereinafter described.

Referring now to FIGS. 118 and 118A of the drawings an arcuate housing220 is further illustrated with pivot holes 220A that extend to definepivot hole slots 220B, each of the latter fitted with a counterbore220D, having a corresponding counterbore slot 220E. The respective setsof pivot holes 220A, pivot hole slots 220B, counterbores 220D andcounterbore slots 220F are spaced-apart with respect to each other forreceiving the respective levers 225D of the forked blades 225 (notillustrated) in the counterbores 220D, as hereinafter further described.A pair of downwardly-extending housing tabs 220G project from theunderside of the housing 220 and are fitted with housing tab extensions220J and corresponding housing tab weld attachment grooves 220K (FIG.118A), for receiving and welding a pair of direction cables 1248, asillustrated in FIG. 114 and as hereinafter further described. Thehousing 220 is further characterized by a curved housing inner wall 220Land is terminated by housing ends 220C, as further illustrated in FIGS.118 and 118A.

As illustrated in FIGS. 114 and 119 of the drawings the driver 230 andthe housing 220 are illustrated inserted in the case 210 in functionalrelationship, such that the respective pivot holes 220A and extendingpivot hole slots 220B provided in the housing 220, face upwardly betweenthe inner wall 210B and the outer wall 210C of the case 210. Due to thepresence of the locking slots 210E and the wider sections 210F, it willbe appreciated that both the housing 220 and the driver 230 can beinserted in the case 210, with the driver tabs 230D, driver tabextensions 230L, housing tabs 220G and housing tab extensions 220Jextending through the wider sections 210F, respectively. Furthermore,the housing 220 and driver 230 can then increment in concert inside thefixed case 210, throughout the length of the two locking slots 210E, asfurther hereinafter described.

Referring now to FIG. 120 of the drawings the arcuate needle 50 isillustrated seated in the respective top face slots 225A of three,spaced-apart forked blades 225. The needle 50 is fitted with a length ofthread 50A, typically attached to the approximate center of the needle50. The respective top face slots 225A in each of the forked blades 225are each defined by oppositely-disposed, curved blade extensions 225Ethat project from a pivot shaft section 225B, fixed to an underlyingbase section 225C that extends to define an inwardly-extending lever225D, as illustrated. The inside one of each of the blade extensions225E is further curved to define a pair of inner lock points 225G andthe opposite, or outside ones of the blade extensions 225E areconfigured to define corresponding outer lock points 225F. Accordingly,it will be appreciated from a consideration of FIG. 120 that therespective forked blades 225 can be rotated in either the clockwise orcounterclockwise direction by corresponding pressure applied to thelevers 225D, to effect engagement of the respectivediametrically-opposed sets of inner lock points 225G and outer lockpoints 225F with the needle 50, to drive the needle 50 in a clockwise orcounterclockwise direction responsive to incrementation of the housing220 and the driver 230 (not illustrated), as further hereinafterdescribed.

Referring now to FIGS. 120 and 121 of the drawings, the housing 220 anddriver 230 are illustrated as installed in the case 210 (FIG. 121),along with the three forked blades 225, (carrying the needle 50 asillustrated in FIG. 120), which are rotatably seated in thecorresponding pivot hole slots 220B, extending the pivot holes 220A inthe housing 220. Accordingly, the forked blades 225 form a bridgebetween the housing 220 and the driver 230, allowing only limitedmovement between these elements and the upper part of each of the forkedblades 225 extends above the respective pivot hole slots 220B to exposethe respective blade extensions 225E, for receiving the needle 50 in thetop face slots 225A. It will be further appreciated from a considerationof FIGS. 120 and 121 that the respective inwardly-extending levers 225D,attached to the corresponding pivot shaft sections 225B, (FIG. 120) aredisposed beneath the driver 230 and the housing 220 (FIG. 121) forpurposes which will be hereinafter further described.

Referring now to FIGS. 120 and 122 of the drawings the housing 220 ispositioned with the adjacent driver 230 in functional relationship andwith the needle 50 located in the top face slots 225A of the forkedblades 225, as detailed in FIG. 120. Furthermore, the respective levers225D extend from the corresponding pivot shaft sections 225B and basesections 225C of each forked blade 225, into the respective counterboreslots 220E in the housing 220 and project into the corresponding,adjacent bearing slots 230A of the driver 230. Accordingly, it will beappreciated that shifting of the housing 220 in either the clockwise orcounterclockwise direction with respect to the driver 230 bymanipulation of a suitable operator (not illustrated) causes thecorresponding wall of the counterbore slots 220E and the correspondingbearing slot wall 230G, projecting into the corresponding bearing slot230A of the driver 230, to contact and pivot each of the levers 225D.This action causes the corresponding diametrically-opposed sets of theouter lock points 225F and inner lock points 225G on the respectivecurved blade extensions 225E to contact the needle 50 and facilitates acorresponding incrementation of the needle 50 by correspondingincrementation of the housing 220 and the driver 230 in the oppositedirection, as hereinafter further described.

As further illustrated in FIGS. 114, 120 and 122 of the drawings thedriver tabs 230D, extending downwardly in spaced-apart relationship fromthe bottom of the driver 230 through the locking slots 210E in the case210 (FIG. 114) arc oriented such that the corresponding driver tabextensions 230L, projecting from the respective driver tabs 230D, arepositioned to receive and anchor the drive cables 1247, respectively,for operating the driver 230, as further illustrated in FIG. 114. In asimilar manner, the pair of housing tabs 220G extending downwardly fromfixed attachment to the underside of the housing 220 are provided withcorresponding housing tab extensions 220J for receiving and anchoring aset or pair of direction cables 1248 (FIG. 114). The direction cables1248 are disposed for incrementing the housing 220 with respect to thecase 210 and the driver 230 and pivoting of the respective forked blades225 to engage a selective diametrically-opposed set of the outer lockpoints 225F and inner lock points 225G, respectively, (FIG. 120), intocontact with the needle 50 and allow either counterclockwise orclockwise rotation of the needle 50, as further hereinafter described.

Referring to FIGS. 113, 123 and 124 of the drawings an arcuate fixed way240 is illustrated and is terminated by downwardly-extending endsegments 240A, with a gap or opening provided between the respective endsegments 240A that corresponds substantially to the gap 205 and theneedle gap 105A illustrated in FIG. 113. A pair of middle segments 240B(FIG. 124) are also illustrated in the fixed way 240, which middlesegments 240B do not extend below the plane of the fixed way 240, asillustrated in FIG. 124. Curved notches 240C are provided between therespective end segments 240A and the middle segments 240B as furtherindicated in FIG. 124 and guide grooves 240D are also spaced-apart inthe fixed way 240, which guide grooves 240D communicate with flaredconical entry guides 240G located in the middle segments 240B and theend segments 240A of the fixed way 240. The guide grooves 240D areslightly undersized with respect to the needle 50 to retain the needle50 in successive incremented positions during return of the respectiveforked blades 225 to the driving configuration after incrementation withthe housing 220 and the driver 230, as hereinafter described. Opposingway covers 240F extend around substantially the entire curvature of thefixed way 240 to define an arcuate thread slot 240E, which is narrowerthan the diameter of the needle 50 to facilitate retention of the needle50 in the guide grooves 240D and the fixed way 240 and clearance of thethread 50A as the needle 50 traverses the fixed way 240. The fixed way240 is typically constructed of plastic and may be permanent ordisposable, such that the needle 50 is snapped in and out, as desired.

Illustrated in FIG. 125 of the drawings are the case 210, with thehousing 220 (hidden, and the forked blades 225 in place) and the driver230 (hidden beneath the fixed way 240) and with the way covers 240F ofthe fixed way 240 removed for brevity. Further illustrated is theunderlying needle 50, seated in the top face slots 225A between theblade extensions 225E of the respective forked blades 225. Accordingly,as further illustrated in FIG. 125 the needle 50 is illustrated insertedin the top face slots 225A of the respective forked blades 225 andbetween the corresponding opposed outer lock points 225F and inner lockpoints 225G of the facing blade extensions 225E. It will be furtherappreciated from a consideration of FIG. 125 that the fixed way 240typically snaps onto the case 210 by a suitable tab and slot combination(not illustrated) and covers both the housing 220 and the driver 230,allowing pivoting action of each of the forked blades 225 responsive tooperation of the respective drive cables 1247, as illustrated in FIG.114 and hereinafter described.

Referring again to FIGS. 1, 64, 65, 66, 77, 78 and 114 of the drawings,the respective drive cables 1247 and direction cables 1248 typicallyextend from fixed attachment to the corresponding driver tab extensions230L and housing tab extensions 220J, respectively, through theclearance tunnels 775A and 775B in the socket 775, as illustrated inFIG. 114. From the socket 775, the drive cables 1247 and directioncables 1248 typically extend through the joint ball 780 and thetransition guide cone 1238 (FIG. 64) and through the transmission tube1200 to the reciprocation input collar 1216 and the direction actuator1214, respectively, illustrated in FIG. 1 of the drawings. At that pointthe drive cables 1247 are typically connected to the reciprocation inputcollar 1216 and trigger 1267 mechanism as heretofore described withrespect to FIGS. 41-55 of the drawings. The direction cables 1248 aretypically connected to the direction actuator 1214 apparatus asdescribed with respect to FIGS. 65, 66, 77 and 78 of the drawings.

In operation, one of the forked blades 225 of the forked blade device201 (FIG. 113) is illustrated in neutral configuration in FIG. 126. FIG.126 illustrates a forked blade 225 with the needle 50 extended throughthe top face slot 225A, defined by the oppositely-disposed bladeextensions 225E. Accordingly, the oppositely-disposed sets of outer lockpoints 225F and inner lock points 225G are not touching the needle 50,since the lever 225D of each forked blade 225 is not yet rotated in thebearing slot 230A of the driver 230 responsive to rotation of thehousing 220.

Referring now to FIGS. 126A and 127 of the drawings the forked blades225 are each rotated in the clockwise direction indicated by theclockwise blade rotation arrows 250B to contact diagonally ordiametrically-opposed sets of the outer lock points 225F and the innerlock points 225G with the softer needle 50. This contact is effectedalong with the clockwise rotation of the forked blade 225 by clockwiserotation of the housing 220 in the direction of the clockwisehousing/driver/needle rotation arrow 250A, to facilitate movement of thelever 225D in the direction of the clockwise blade rotation arrow 250B(FIG. 126A), as illustrated. Accordingly, contact between the edge ofthe counterbore slot 220E in the housing 220 and the lever 225D pivotsthe lever 225D in the clockwise direction in a camming action, asindicated by the clockwise blade arrow rotation 250B, since theextending end of the lever 225B engages the bearing slot wall 230G inthe bearing slot 230A (illustrated in phantom in FIG. 126A) of thedrives 230. Consequently, the needle 50 is now in position forcounterclockwise rotation in concert with the housing 220 and the driver230 in the direction of the counterclockwise housing/driver/needlerotation arrow 250C.

Movement of the housing 220 initially in the clockwise direction asindicated by the clockwise housing/driver/needle rotation arrow 250A toseat the forked blades 225 against the needle 50 is effected bytensioning the two direction cables 1248, illustrated in FIG. 114, byoperation of suitable direction actuator 1214 apparatus such as thatillustrated in FIG. 1 of the drawings, as heretofore described.Furthermore, subsequent rotation of the housing 220 and the driver 230together in the counterclockwise direction to carry the needle 50 in thesame direction as illustrated in the counterclockwisehousing/driver/needle rotation arrow 250C, is effected by repetitivelytensioning the two drive cables 1247 attached to the driver tabextensions 230L of the driver 230. This action is typically initiated byoperation of the reciprocation input collar 1216 and trigger mechanism1267 also illustrated in FIG. 1, and moves the corresponding driver tabs230D along the length of the respective locking slots 210E in the case210, to increment the housing 220, the driver 230 and the needle 50 inthe counterclockwise direction around the fixed way 240, as heretoforedescribed. Alternatively, other drive mechanisms may be provided inconnection with the housing 220 and/or the driver 230, including bevelgear drives, direct flexible cable drives and rack and pinion drivecomponents, in non-exclusive particular, as illustrated and described inthe various embodiments of this invention.

Referring now to FIGS. 128 and 128A of the drawings under circumstanceswhere it is desired to increment and drive the needle 50 in theclockwise direction around the fixed way 240, the procedure forcounterclockwise incrementation illustrated in FIGS. 126A and 127 anddescribed above is reversed, as follows. The forked blades 225 areinitially caused to rotate in the counterclockwise direction (in thedirection of the counterclockwise blade rotation arrow 250D) bycorresponding initial counterclockwise rotation of the housing 220, asillustrated by the counterclockwise housing/driver/needle rotation arrow250C (FIG. 128). This action causes the desired rotation of the forkedblades 225 to effect engagement of diagonally or diametrically-opposedsets of the respective outer lock points 225F and inner lock points 225Gon the corresponding blade extensions 225E in the forked blades 225,with the softer needle 50, as illustrated. Accordingly, theseneedle-engaging outer lock points 225F and inner lock points 225G arepositioned to effect clockwise rotation of the needle 50 (FIG. 128A) inthe guide grooves 240D of the fixed way 240 (FIG. 123) uponcorresponding rotation of the housing 220 and the driver 230 in concertin the direction of the clockwise housing/needle rotation arrow 250A. Asin the case of the counterclockwise rotation of the needle 50illustrated in FIGS. 126A and 127, the initial rotation of the housing220 to effect corresponding the opposite clockwise rotation of theforked blades 225 to the position illustrated in FIG. 128, is typicallyeffected by tensioning of the two direction cables 1248 with fingerpressure exerted on the direction actuator 1214 located on thetransmission tube 1200, as illustrated in FIG. 1 and as furtherhereinafter described. Driving of the needle 50 along with the housing220 and driver 230 in concert in the clockwise direction is effected bytensioning the two drive cables 1247, typically using the triggermechanism 1267, to increment the reciprocation input collar 1216, asfurther illustrated in FIG. 1.

Referring now to FIGS. 1, 54-58, 113, 126A, 127 and 129-133 of thedrawings under circumstances where the needle 50 is to be incremented inthe counterclockwise direction according to the procedure illustrated inFIGS. 126A and 127, the forked blade device 201 is initially positionedwith respect to a material 100 to be sutured, such that the material 100projects into the gap 205 and needle gap 105A (FIG. 113) in the path ofthe needle 50, as illustrated in FIG. 129. The housing 220 is thenincremented in the clockwise direction as illustrated in FIG. 126A,typically by manipulating the direction actuator 1214 in thetransmission tube 1200 (FIG. 1), to initially pivot the forked blades225 in the configuration illustrated in FIG. 129. This positioning ofthe forked blades 225 engages the respective diametrically-opposed outerlock points 225F and inner lock points 225G with the needle 50 asdescribed with respect to FIG. 126A and facilitates rotation of thehousing 220 and the driver 230, along with the needle 50, in thecounterclockwise direction along the length of the two locking slots210E, as illustrated by the counterclockwise/housing/driver/needlerotation arrow 250C in FIG. 130. The housing 220 and driver 230 are thenreversed, typically by spring action, as in the trigger 1267 andreciprocation collar 1216 combination described above, (FIGS. 1 and54-58), back to the position illustrated in FIG. 129, leaving the needle50 in place, as illustrated. Further rotation of the needle 50 in thefixed way 240 is illustrated in FIG. 131, where the needle 250 continuesto penetrate the material 100 with the thread 50A following, as thethread 50A traverses the thread slot 240E defined by the way covers 240Fin the fixed way 240. Continued sequential incrementation of the housing220 and the driver 230 in concert, typically by operation of the trigger1267 in the transmission tube 1200, effects continued rotation of theneedle around the fixed way 240 as illustrated in FIGS. 132 and 133,with the thread 50A following through the opening in the material 100created by the needle 50, as illustrated. Accordingly, the needle 50 hasthe capability of encircling its own trailing length of thread 50A toquickly and efficiently suture a wide variety of knots in any type ofmaterial 100.

As described above with respect to FIGS. 128 and 128A of the drawingsclockwise rotation of the needle 50 in the fixed way 240 is initiallyeffected by corresponding counterclockwise incrementing of the housing220 and then, clockwise movement of the housing 220 and the driver 230to facilitate incrementing the needle 50 in the clockwise direction, asillustrated in FIG. 128A of the drawings. Furthermore, in both clockwiseand counterclockwise incrementing of the needle 50, as the needle 50rotates into the position illustrated in FIG. 133, thread-handlingdevices such as the thread incrementing accessory 1101, illustrated inFIG. 40A of the drawings can be mounted on the case 210 and used toincrement the thread 50A as heretofore described with respect to FIG.40A.

Referring now to FIGS. 134 and 135 of the drawings an alternativeconfiguration of the forked blades 225 illustrated in FIG. 120 isprovided in the simple forked blade 226. The simple forked blade 226includes an inner blade 226D and an outer blade 226E, extending upwardlyfrom a lever 225D and having outer blade lock points 226A on the outerblade 226E and inner blade lock points 226B on the inner blade 226D, asillustrated. Accordingly, pivoting of the lever 225D in the clockwisedirection as indicated by the clockwise blade rotation arrow 250B inFIG. 135 as heretofore described, facilitates contact between therespective diagonally-opposed outer blade lock points 226A and innerblade lock points 226B with the needle 50. In a preferred embodiment ofthe invention the relative hardness of the respective inner blades 226Dand the outer blades 226E with respect to the material of constructionof the needle 50 is such that contact between the respective outer bladelock points 226A and inner blade lock points 226B with the softer needle50 causes impressions 226C and burrs 226F to be shaped, formed or cut inthe surface of the needle 50. These burrs 226F facilitate a better gripof the respective inner blades 226D and outer blades 226E on the needle50, as further illustrated in FIG. 135. As in the case of the forkedblade 225 embodiment illustrated with respect to FIGS. 127-133 of thedrawings, incrementation of the needle 50 is typically effected byoperation of the trigger mechanism 1267 and the correspondingreciprocating input collar 1216 in the transmission tube 1200illustrated in FIG. 1.

In another preferred embodiment of the invention an alternative blade227 is illustrated in FIGS. 136-138 and is fitted with a lever 225D, towhich is attached a pivot shaft section 225B, upon which is mountedoppositely-disposed blade posts 227A, one of which blade posts 227A hasa pair of outer lock points 225F and the other of which is fitted withinner lock points 225G. As in the case of the embodiments illustratedabove, the outer lock points 225F and inner lock points 225G aredesigned to engage the needle 50 in diametrically-opposed relationshipand effect incrementation of the needle 50 around the fixed way 240 bydriving of the housing 220 and the driver 230 in concert in thecounterclockwise or clockwise direction, as heretofore described.

Referring again to FIGS. 120, 125 and 126A of the drawings, it will beappreciated that the design of the forked blades 225 (as well as thesimple forked blades 226 and the alternative forked blades 227)facilitates firm gripping of the needle 50 in the driving direction,yet, minimal rearward application of force on the needle during returnof the housing 220 and driver 230. For example, as illustrated in FIG.126A the diametrically-opposing outer lock points 225F and inner lockpoints 225G present to the surface of the needle 50 two differentslopes. The slope that faces the direction of needle incrementation issteep in each case, to resist rearward forces and drive the needle 50onward in the fixed way 240. In control, the opposite slopes of eachlock point facing away from needle advancement are disposed at a shallowangle with respect to the surface of the needle 50. This design featurefacilitates sliding of the outer lock points 225F (and 226A) and innerlock points 225G (and 226B), respectively, over the surface of theneedle 50 without moving the needle 50 rearwardly when the housing 220and driver 230 reverse direction.

It will be appreciated by those skilled in the art that the forked bladedevice of this invention facilitates a simple and efficient apparatusfor incrementing the needle 50 in either the counterclockwise orclockwise direction responsive to the operation of an operator such asthe transmission tube 1200 illustrated in FIG. 1 and as described above.Furthermore, various forked blade designs are possible as describedabove, for engaging variously designed outer lock points and inner lockpoints to effect either counterclockwise or clockwise incrementation ofthe needle in the fixed way of the device.

Referring to FIGS. 139-156 of the drawings a tubular forked blade deviceis generally illustrated by reference numeral 300 and includes agenerally tubular-shaped fixed support frame 310 having a lower fixedsupport frame tubular portion 310D, fitted with a fixed support framerotational slot 332D (FIG. 140). A central post 313C is upward standingfrom the lower fixed support frame tubular portion 310D and terminatesin an arcuate top section 313D, that includes three upward-standingfixed segments 310A, 3103B and 310C, spaced-apart by notches 311A and311B, as further illustrated in FIG. 140. A material gap 305 is providedadjacent the fixed segments 310A and 310C in order to receive and suturematerial 100 (illustrated in FIGS. 148 and 149), responsive to operationof the tubular forked blade device 300, as hereinafter furtherdescribed. The gap edges 305B and 305C define the material gap 305 andthe material gap 305 corresponds essentially to the width of the needlegap 305A of an arcuate needle 50, as further illustrated in FIG. 140.The needle 50 typically has sharp needle points 341A and 3411B andincludes a length of thread 50A, typically extending from the centerthereof as illustrated. However, it will be appreciated by those skilledin the art that the needle 50 can be sharp on one end only and thethread attached to the opposite end by techniques known to those skilledin the art under circumstances where it is desired to use a tubularforked way device 300 for suturing in one needle rotational directiononly.

As further illustrated in FIG. 139-141 of the drawings and particularlyin FIG. 140, a discontinuous fixed guide way 312 is shaped in each ofthe upward-standing fixed segments 310A, 3101B and 310C for receivingthe needle 50 and a fixed segment overhang 312A, 312B and 312C is alsoprovided in each one of the fixed segments 310A, 3101B and 310C,respectively, for maintaining the needle 50 in place in the undercutdiscontinuous fixed guide way 312. The needle 50 is further maintainedin position in the discontinuous fixed guide way 312 by means of aspring pressure pad assembly 314, more particularly illustrated in FIGS.142-144. The spring pressure pad assembly 314 is further characterizedby an arcuate spring base 314G, having a spring base raised rim 314H forseating in a corresponding shallow recess 313E, provided in the arcuatetop section 313D of the fixed support frame 310. Mounting springs 314D,314E and 314F (FIG. 142) extend upwardly in spaced-apart relationshipwith respect to each other from the spring base 314G and carryspring-mounted friction and retaining pads 314A, 314B and 314C,respectively. Accordingly, it will be appreciated from a considerationof FIGS. 139 and 144 of the drawings that the spring conical entranceguides 314 I and adjacent way segments 318A, 318B and 318C, provided onthe spring-mounted friction and retaining pads 314A, 314B and 314C,respectively, are disposed opposite the discontinuous fixed guide way312 provided in the corresponding fixed segments 310A, 310B and 310C.Since the needle 50 is designed to increment in the discontinuous fixedguide way 312 and the corresponding way segments 318A, 318B and 318C ofthe spring pressure pad assembly 314, the needle 50 is maintained inposition for 360-degree rotation around the upper portion of the fixedsupport frame 310, as hereinafter described.

Referring again to FIGS. 139-140 of the drawings a middle tube assembly320 is provided with a tubular shaped lower middle tube portion 320Chaving an open interior and a middle tube rotational slot 332C,projecting through the wall of the lower middle tube portion 320C insubstantial alignment with the fixed support frame rotational slot 332D.A middle tube post 320G extends upwardly from the top edge of the lowermiddle tube portion 320C and mounts a curved upper middle tube portion320AB, fitted with a pair of spaced-apart blade housings 320A and 320B,designed to receive corresponding pivoting blades 350A and 350B,respectively. The lower middle tube portion 320C of the middle tubeassembly 320 is designed to fit concentrically inside the lower fixedsupport frame tubular portion 310D and is allowed to rotate to a limitedextent therein, as illustrated in FIG. 139.

As further illustrated in FIGS. 139 and 140 of the drawings a drive spur330 is provided with a lower drive spur tubular portion 332 that fitsconcentrically inside the lower middle tube portion 320C of the middletube assembly 320 (FIG. 139). A drive spur hole 332B is provided in thewall of the lower drive spur tubular portion 332 and a locator pin 332Aextends through the drive spur hole 332B and into the aligned middletube rotational slot 332C and the fixed support frame rotational slot332D, for purposes which will be hereinafter described. An inner tubularpost 330F extends upwardly from the lower drive spur tubular portion 332and terminates in an extension mount 330AB, shaped to define a firstleverage extension 330A and a second leverage extension 330B,spaced-apart with respect to each other.

Referring again to FIGS. 139-141 of the drawings under circumstanceswhere the tubular forked blade device 300 is assembled as illustrated inFIGS. 139 and 141 a spring pressure pad assembly 314 is mounted on thearcuate top section 313D, with the corresponding fixed segment 310A,310B and 310C, respectively, facing the respective spring-mountedfriction and retaining pads 314A, 314B and 314C on the fixed supportframe 310 (FIG. 139). This arrangement facilitates capturing the needle50 in the opposing discontinuous fixed guide way 312 in the fixedsegments 310A, 3103B and 310C and in the respective way segments 318A,318B and 318C, shaped in the corresponding spring-mounted friction andretaining pads 314A, 314B and 314C of the spring pressure pad assembly314, as well as in the discontinuous movable guide way 321, located inthe tube blade housings 320A, and 320B on the upper middle tube portion320AB (FIG. 140). In a preferred embodiment of the invention the needle50 is slightly oversized with respect to the discontinuous fixed guideway 312 and the discontinuous movable guide way 321 to facilitateapplication of a slight frictional resistance to rotational movement ofthe needle 50 during operation of the tubular forked blade device 300,as hereinafter further described. However, the spring pressure padassembly 314 facilitates acceptance of needles 50 having a variablediameter.

As further illustrated in FIGS. 139, 140, 141 and 145-146 of thedrawings the blades 350A and 350B are pivotally mounted in correspondingblade housings 320A and 320B and are each characterized by slots 350Cand 350D, respectively, designed to transversely receive the needle 50.Pivot pins 352A and 352B extend downwardly from the levers 354C and354D, respectively, of the corresponding blades 350A and 350B. In apreferred embodiment the short ends 352C and 352D (not illustrated)project from the slotted ends of the levers 354C and 354D, respectively,for insertion under overhanging undercut ledges 354A and 354B,respectively, provided in the movable segment overhang 312D and 312E,respectively, of the respective blade housings 320A and 320B of themiddle tube assembly 320. The pivot bearing holes 322C and 322D (notillustrated) respectively, are provided in the respective floors 322Aand 322B of the corresponding blade housings 320A and 320B between theupward-standing shelves 320D and 320E, respectively. In a preferredembodiment the pivot bearing holes 322C and 322D are each provided withramps 322E and 322F (not illustrated) respectively, to facilitateaccommodation of the respective pivot pins 352A and 352B, for insertingthe respective blades 350A and 350B into the corresponding pivot bearingholes 322C and 322D, respectively, while assembling the blades in thecorresponding blade housings 320A and 320B. Accordingly, when therespective blades 350A and 350B are assembled in the corresponding bladehousing 320A and 320B of the middle tube assembly 320 they areconstrained to pivot on the corresponding pivot pins 352A and 352B,respectively, as illustrated in FIG. 146 (with respect to the blade350A), such that the corresponding slot 350C engages the needle 50 andallows rotational movement of the needle 50 in the correspondingdiscontinuous movable guide way 321 when the blade 350B is positionedperpendicular to the curvature of the needle 50 in a radius of the uppermiddle tube portion 320AB of the middle tube assembly 320. However, whenthe blade 350A is pivoted in either direction as indicated by the arrowin FIG. 146, the edges of the blade 350A along the slot 350C engage theneedle 50 and facilitate incrementation of the needle 50 in a drivingdirection and slippage of the needle 50 past the blade 350A in theopposite direction, as hereinafter further described. In anotherpreferred embodiment of the invention the discontinuous movable guideway 321 formed in the shelves 320D and 320E, respectively, as well as inthe facing inside wall of the respective blade housings 320A and 320B,respectively, and the discontinuous fixed guide way 312 in the fixedsegments 310A, 310B and 310C, are provided with conical entrance guides312L to guide the needle 50 in its rotation around the respective bladehousings 320A and 320B in the upper middle tube portion 320AB and thecorresponding fixed segments 310A, 310B and 310C of the arcuate topsection 313D.

As further illustrated in FIGS. 141, 148 and 149 of the drawingspivoting of the respective blades 350A and 350B—on the respective pivotpins 352A and 352B in the corresponding blade housing 320A and 320B isfacilitated by the provision of angled walls 334A, 334B, 334C and 334D,provided in the respective cavities 330C and 330D, which are undercut inthe corresponding first leverage extension 330A and second leverageextension 330B in the extension mount 330AB of the drive spur 330 (FIGS.148 and 149). These openings allow free movement of the respectivelevers 354C and 354D of the blades 350A and 350B, respectively, tofacilitate selective gripping of the needle 50 by the sides or edgesbordering the corresponding slots 350C and 350D of the correspondingblades 350A and 350B.

Referring now to FIG. 147 of the drawings in an alternative bladedesign, the blades 350A and 350B (not illustrated) are eachcharacterized by levers 354C and 354D (not illustrated) respectively,that terminate at one end in the cavities 330C and 330D in therespective first leverage extension 330A and second leverage extension330B, respectively, of the drive spur 330, as described above (FIGS. 148and 149). The opposite ends of the blades 350A and 350B are squared offand, as illustrated, the end of the blade 350A fits beneath the arcuatemovable segment overhang 312D of the illustrated blade housing 320A.Furthermore, each of the pivot pins 352A and 352B (not illustrated)respectively, project through a corresponding pivot bearing hole 322C(FIG. 147) and 322D (not illustrated) and one or more discs 351A (FIG.147) and 351B (not illustrated) are press-fitted or welded on theextending ends of the respective pivot pins 352A and 352B (notillustrated) in the countersinks 351K and 351L (not illustrated), tofacilitate mounting of the respective blades 350A and 350B on thecorresponding blade housings 320A and 320B, without the necessity ofproviding corresponding ramps 322E and 322F in the blade housing 320Aand 320B, illustrated in FIG. 145.

As illustrated in FIGS. 150, 151 and 152 of the drawings in a preferredembodiment of this and other embodiments of the invention the arcuateneedle 50 is fitted with a length of thread 50A at or near the centerthereof, by the provision of a needle eye 340B, which is shaped todefine a shallow cavity 340F at the bottom end and an upper shallowcavity 340J at the opposite upper end thereof, as illustrated in FIGS.151 and 152. The thread 50A is fitted with a stop 340D and a secondarystop 340E at the anchored or thread head end 340C, as furtherillustrated in FIGS. 151 and 152. The area between the stop 340D andsecondary stop 340E is concave in configuration to match the internalcurvature of the needle eye 340B when the thread 50A is tightened in thelower shallow cavity 340 F and upper shallow cavity 340J of the needleeye 340 B. Accordingly, the thread head end 340C essentially fills theshallow cavity 340F of the needle eye 340B to prevent the thread 50Afrom being pulled from the needle 50 when tensioned during the suturingoperation. In a preferred embodiment of the invention that portion ofthe thread 50A which extends from the secondary stop 340E upwardly to apredetermined distance is configured to define a flattened hinge 340H tofacilitate passage of the needle 50 through tissue (not illustrated) andallow the thread 50A to lie flat against the needle 50 and thus minimizetissue damage due to passage of the thread 50A through the tissue withthe needle 50. In another preferred embodiment of the invention theflattened hinge 340H segment of the thread 50A is smaller than that ofthe thread normal gauge, for a distance slightly greater than half thecircular length of the needle. Beyond this distance the diameter of thethread 50A can be larger than the needle 50, to minimize leakage in thetissue, as desired.

Referring now to FIGS. 153-158 of the drawings the tubular forked bladedevice 300 is illustrated connected to a main tubular extension 364,with an outer flexible tube 360 projecting from the lower fixed supportframe tubular portion 310D of the fixed support frame 310. Furthermore,a middle flexible tube 360A is concentric to the outer flexible tube 360and is connected to the lower middle tube portion 320C of the middletube assembly 320 by means of a notch 360M, provided in the lower middletube portion 320C, for receiving a corresponding notch boss 360N on themiddle flexible tube 360A, as illustrated. Furthermore, an innerflexible tube 360B is concentric to the middle flexible tube 360A andthe outer flexible tube 360 and is connected to the corresponding lowerdrive spur tubular portion 332 of the drive spur 330. The locator pin332A is further illustrated extending through the respective drive spurhole 332B in the lower drive spur tubular portion 332, the middle tuberotational slot 332C in the lower middle tube portion 320C and thecorresponding fixed support frame rotational slot 322D in the lowerfixed support frame tubular portion 310D of the fixed support frame 310.Accordingly, initial manipulation of the inner flexible tube 360B andthen the middle flexible tube 360A effects a correspondingincrementation of the drive spur 330 and rotation of the middle tubeassembly 320 and the drive spur 330, to first increment the blades 350Aand 350B against the needle 50 in the corresponding blade housings 320Aand 320B, respectively, and then rotate the needle 50 around the tubularforked blade device 300 for suturing purposes. Incrementation of theinner flexible tube 360B throughout the range of motion allowed by thelocator pin 332A facilitates limited incrementation of the drive spur330 with respect to the middle tube assembly 320. This movementfacilitates pivoting of the respective blades 350A and 350B into contactwith the needle 50A to determine the direction of rotation of the needle50, as hereinafter further described.

Referring again to FIGS. 154 and 155 of the drawings under circumstanceswhere it is desired to manipulate the tubular forked blade device 300into position for suturing in a wound or incision, positioning of theneedle 50 to the desired location can be effected by tensioning one ofthe three cables 396. The cables 396 extend in radially spaced-apartrelationship through corresponding cable holes 396A, 396B and 396C,respectively, provided in the outer tubular extension 364A, illustratedin FIG. 155, to a suitable operator (not illustrated). The opposite endsof the cables 396 are attached to the first flexible tube section 360Cof a series of flexible tube sections 360C-360L, as illustrated in FIG.154. Accordingly, tensioning of a selected one of the cables 396facilitates bending of the outer flexible tube 360, including the outertubular extension 364A, as well as the middle tubular extension 364B andthe inner tubular extension 364C in concert, as illustrated in FIG. 154,typically to the position illustrated in phantom. In a preferredembodiment of the invention the flexible tube sections 360C-360L areconstructed such that they typically operate as a “gooseneck” device,such that positioning of the tubular forked blade device 300 in adesired position for suturing by the needle 50 is maintained afteradjustment of the respective cables 396, by friction between therespective adjacent flexible tube sections 360C-360L.

As illustrated in FIGS. 154, 155, 156, 157 and 158 of the drawings thetubular forked blade device 300 can typically be operated to drive theneedle 50 in the suturing configuration illustrated in FIGS. 148 and 149using the extension structure 390 (FIG. 157). The extension structure390 includes the outer tubular extension 364A, middle tubular extension364B and inner tubular extension 364C illustrated in FIG. 155, whereinthe middle tubular extension 364B is fitted with a direction-changinglever 397, as further illustrated in FIGS. 156 and 157. Referring againto FIG. 156 the direction-changing lever 397 is connected to the middletubular extension 364B and extends radially inward in the main tubularextension 364 to rest against a setting spring 397C, fixed to the innertubular extension 364C at setting spring attachment points 397D. Thesetting spring 397C is biased against the extending end of thedirection-changing lever 397, such that rotation of thedirection-changing lever 397 in the clockwise direction as illustratedin FIG. 156 moves the direction-changing lever 397 from the positionillustrated to an alternative adjacent position in the setting spring397C. This movement also rotates the inner tubular extension 364C in theinner flexible tube 360B, the lower drive spur tubular portion 332 andthe first leverage extension 330A and second leverage extension 330B onthe drive spur 330. The movement further increments the blades 350A and350B into the clockwise or counterclockwise rotational configuration forsuturing operation of the needle 50, as hereinafter further described.

As further illustrated in FIGS. 156, 157 and 158 a motor 398F is fittedwith a motor shaft 398E, to which is attached a gapped gear 398D, havinggapped gear teeth 3981 provided around a portion of the peripherythereof and fitted with a gear gap 398J in the gapped gear teeth 3981,as illustrated in FIG. 156. As further illustrated in FIG. 156 thegapped gear teeth 3981 typically engage corresponding drive gear teeth398H provided on the drive gear extension 398A of a drive gear 398 andextending around the periphery of the outer tubular extension 364A, fordriving the drive gear 398 and the inner tubular extension 364C in theclockwise or counterclockwise direction, responsive to the direction ofrotation of the motor shaft 398E and the gapped gear 398D. Referringagain to FIG. 158 of the drawings, in a preferred embodiment of theinvention an extension tube assembly interface mount 399 is provided onthe main tubular extension 364 for mounting the motor 398F and thegapped gear 398D in driving relationship with respect to the drive gearextension 398A of the drive gear 398. Since the drive gear extension398A projects from fixed attachment to the inner tubular extension 364C,(through the middle tube drive slot 398C in the middle tubular extension364B and the outer tube drive slot 398B in the outer tubular extension364A) and engages the gapped gear 398D, the drive gear 398 is able tomove in both the counterclockwise and clockwise direction responsive tothe driving of the gapped gear 398D. This action rotates the needle 50around the tubular forked blade device 300. Furthermore, since thegapped gear 398D is fitted with a smooth gear gap 398J in which nogapped gear teeth 3981 are provided, upon rotation of the gapped gear398D to the point of disengagement of the corresponding gapped gearteeth 3981 with the drive gear teeth 398H of the drive gear extension398A, the drive gear 398 and the main tubular extension 364 return tothe original position by operation of a tube return spring 398G,illustrated in FIG. 156.

As further illustrated in FIGS. 157 and 158 the main tubular extension364 can be rotated along its longitudinal axis to properly position theneedle 50 in or near a wound or incision (not illustrated) by moving themain tubular extension 364 linearly forwardly or rearwardly to disengagethe drive gear extension 398A from the gapped gear 398. This allowsrotation—of the main tubular extension 364 and re-engagement of thegears, as necessary.

In operation, referring again to FIGS. 140, 148 and 149 of the drawings,the needle 50 is caused to traverse the respective discontinuous fixedguide way 312 in the fixed segments 310A, 310B and 310C, the waysegments 318A, 318B and 318C in the spring pressure pad assembly 314, aswell as the corresponding discontinuous movable guide way 321 in theblade housing 320A and 320B of the tubular forked blade device 300. Thistraverse action is effected typically by operation of the main tubularextension 364, using the drive gear 398 and the gapped gear 398D of theextension structure 390, illustrated in FIGS. 153-158. It will beappreciated that other drive systems can also be utilized as desired, toincrement the drive spur 330 and pivot the respective blades 350A and350B in the blade housing 320A and 320B, respectively, and facilitate aselected directional rotation of the needle 50 in the suturingoperation.

Accordingly, referring initially to FIG. 148 of the drawings whereinclockwise advancement of the needle 50 in the direction of the arrow isillustrated, each of the blades 350A and 350B, located in thecorresponding blade housing 320A and 320B of the middle tube assembly320, are pivoted in the counterclockwise direction to engage the softerneedle 50, either individually or in concert, and effect the desiredrotation of the needle 50, responsive to rotation of the middle tubeassembly 320 and the drive spur 330 together. In order to effectclockwise rotation of the needle 50 the drive spur 330 is initiallyincremented in the clockwise direction as illustrated by the arrowsuperimposed on the extension mount 330AB of the drive spur 330. Thisrotational movement of the drive spur 330 (within the span of the middletube rotational slot 332C with respect to the locator pin 332A) effectscontact between the angled wall 334A and the lever 354C in the cavity330C of the first leverage extension 330A and the corresponding angledwall 334C and the lever 354D in the cavity 330D of the second leveragingextension 330B of the upper middle tube portion 320AB, as furtherillustrated in FIG. 148. Accordingly, considering the location of theneedle 50 in FIG. 148, the sharp edges of the slot 350C in the blade350A contact the softer needle 50 while the blade 350A is in its pivotedconfiguration but the blade 350B does not contact the needle 50, as theblade 350B is in the needle gap 305A. Subsequent rotation of the middletube assembly 320 and the drive spur 330 (in concert in the clockwisedirection indicated by the arrow superimposed on the middle tubeassembly 320) effects corresponding needle rotation in the clockwisedirection, as indicated by the arrow superimposed on the needle 50,through the material 100 with the thread 50A trailing and following theneedle 50 through the needle opening material 100, as illustrated. Thetwo blade housings 320A and 320B in the middle tube assembly 320 movewith the drive spur 330 in an initial incrementation throughout thelength of the respective notches 311A and 311B, provided in the arcuatetop section 313D of the fixed support frame 310. When the respectiveblade housings 320A and 320B reach the end(s) of the respective notches311A and 311B at the fixed segments 310B and 310C, respectively, thedirection of rotation of the middle tube assembly 320 is reversed,typically by the action of the tube return spring 398G (FIG. 156), tofacilitate reverse movement of the blade housings 320A and 320B and themiddle tube assembly 320, along with the drive spur 330, forre-incrementation. When the middle tube assembly 320 and the drive spur330 are reversed in this manner, the needle 50 remains in itsincremented position because of the slight oversize of the needlediameter with respect to the discontinuous fixed guide way 312 and theway segments 318A, 318B and 318C provided in the respectivespring-mounted friction and retaining pads 314A, 314B and 314C,respectively. Furthermore, since the spring pressure pad assembly 314exerts pressure through the spring-mounted friction and retaining pads314A, 314B and 314C on the needle 50 as it moves through thecorresponding discontinuous fixed guide way 312 and the way segments318A, 318B and 318C, this pressure serves to hold the needle 50 inplace, as the middle tube assembly 320 and the drive spur 330re-increment for another incrementation of the needle 50 around thetubular forked blade device 300. Furthermore, due to the position of therespective blades 350A and 350B as they engage the needle 50, the needle50 is allowed to slide in the respective slots 350C and 350D as theblade housings 320A and 320B re-increment in reverse rotation byoperation of the tube return spring 398G.

Under circumstances where it is desired to drive the needle 50 in thecounterclockwise direction around the tubular forked blade device 300 asillustrated in FIG. 149, the blades 350A and 350B are initially pivotedin the clockwise direction as indicated by the arrow superimposed on thelevers 354C and 354D, respectively. This pivoting of the blades 350A and350B is effected by incrementation of the drive spur 330 in thecounterclockwise direction, to effect contact between the respectiveangled wall 334B and the lever 354C in the cavity 330C of the bladehousing 320A and between the angled wall 334D and the lever 354D in thecavity 330D of the blade housing 320B. Locking of the blades 350A and350B in this pivoted position effects securing of the sharp edges of theslot 350C of the blade 350A on the softer needle 50 and, although theblade 350B is not in contact with the needle 50 as the needle 50 isconfigured in FIG. 149, the blade 350A is capable of rotating the needle50 in the counterclockwise direction indicated by the arrow illustratedon the needle 50, by itself. Accordingly, the needle 50 is driventhrough the material 100 with the thread 50A following as illustrated,as the middle tube assembly 320 and the drive spur 330 are driven inconcert in the counterclockwise direction by a suitable operating devicesuch as that illustrated in FIGS. 153-158, as heretofore described.

It will be appreciated from a consideration of FIGS. 139-158 of thedrawings that the tubular forked blade device 300 of this invention canbe positioned in a desired configuration, typically as illustrated inFIG. 155 utilizing the cables 396, to facilitate suturing of a material100 in substantially any suturing configuration. Furthermore, althoughthe tubular forked blade device 300 can be operated by means of the mainmodular extension 364, including the extension structure 390, the drivegear 398 and the gapped gear 398D illustrated in FIGS. 153-158 as notedabove, other apparatus and techniques can be utilized to effectincrementation of the drive spur 330 to cause the blades 350A and 350Bto contact the needle 50 in driving configuration and facilitatesimultaneous driving of the middle tube assembly 320 and the drive spur330 to effect the desired suturing, as illustrated in FIGS. 148 and 149.Furthermore, it will also be appreciated that although the arc of theneedle 50 is fitted with the length of thread 50A at the center thereof,typically as illustrated in FIGS. 150-152 of the drawings, it isunderstood that the thread 50A may be attached to either end of theneedle 50 under circumstances where the needle 50 is to be driven ineither the clockwise or counterclockwise direction, depending upon thepositioning of the needle 50 in the tubular forked blade device 300.Moreover, insertion of the needle 50 in the respective discontinuousguide way 312 of the fixed segments 310A, 310B and 310C, the waysegments 318A, 318B and 318C of the spring pressure pad assembly and thediscontinuous movable guide way 321 in the blade housing 320A and 320B,is typically effected by deforming the needle 50 slightly by bending theneedle points 341A and 341B toward each other to reduce the diameter ofthe needle 50 and facilitate installing it beneath the respective fixedsegment overhangs 312A, 312B and 312C, located in the correspondingfixed segments 310A, 310B and 310C and the movable segment overhangs312D and 312E in the blade housings 320A and 320B. When so installed,the needle 50 receives a small amount of frictional resistance from theoutside walls of the discontinuous fixed guide way 312 and thediscontinuous movable guide way 321 in the movable blade housing 320Aand 320B. This resistance is a contributing factor in prevention of theneedle from rearward rotation after being incremented in the forwarddirection responsive to re-incrementation of the middle tube assembly320 and the drive spur 330 in concert by operation of the tube returnspring 398G (FIG. 156) as described above.

Still another embodiment of the cycling suturing and knot-tying deviceof this invention is illustrated in FIGS. 159-166. Referring initiallyto FIGS. 159 and 161-163 of the drawings the planetary wheel/gear device400 is a reversible needle traversing device which receives a curvedneedle 50 fitted with a length of thread 50A at one end and sharpened atthe opposite end. The arcuate needle 50 is designed to seat in acorrespondingly-shaped fixed way 404 having a fixed way overhang 419 anda fixed way bevel 404A at both ends thereof for guiding the needle 50 inits circular path and including a fixed way outer wall or groove 418(FIG. 162) that is curved to accept the curvature of the needle 50. Thefixed way 404 is provided in a disc body 410 having a gap 405 (FIG.160), as further illustrated in FIG. 162 and is typically provided withmultiple rotatable, beveled toothed rotors 416, rotatably seated incorresponding conical holes 416A, respectively. In a preferredembodiment of the invention there are four toothed rotors 416 rotatablyseated in a corresponding number of the conical holes 416A inspaced-apart relationship around the inner periphery of the fixed way404. However, it will be appreciated by those skilled in the art thatgreater or fewer numbers of the toothed rotors 416 may be provided incorresponding conical holes 416A, in the disc body 410, depending uponthe size of the planetary wheel/gear device 400 and other designconsiderations in the device. A conical central gear 415 is rotatablyseated in the center of the disc body of the planetary wheel/gear device400 (FIG. 159) and includes a central bevel gear 415C, mounted on acentral gear shaft 415A, extending from the bottom of the conicalcentral gear 415 for engaging a corresponding drive shaft bevel gear420B, mounted on a flexible drive shaft 420 (FIG. 161). The flexibledrive shaft 420 is journalled for rotation in a gear bearing block 420D,attached to the disc bottom 410A of the disc body 410 and engaging thecentral bevel gear 415C in driving relationship. The conical centralgear 415 is also provided with a downwardly-flaring, textured or toothedbeveled driving surface 415F that engages corresponding beveled andtextured or toothed rotor surfaces 417 on the toothed rotors 416, asfurther illustrated in FIGS. 161 and 162 of the drawings. Accordingly,rotation of the flexible drive shaft 420 inside the flexible drive shafthousing 420A effects a corresponding rotation of the drive shaft bevelgear 420B and the central bevel gear 415C to rotate the conical centralgear 415 and the respective toothed rotors 416 in a desired direction,as hereinafter further described.

Referring again to FIGS. 159 and 160 of the drawings the disc body 410of the planetary wheel/gear device 400 is attached in articulatingrelationship to a suitable operator 1240 by means of an extensionattachment plate 426 fixed at one end to the operator 1240 and connectedto an adjacent swing plate 424 by means of a vertically-oriented swingplate pin 424A. This connection facilitates movement of the disc body410 from side-to-side responsive to sequential manipulation of fourarticulation cables 1256A, 1256B, 1256C and 1256D (FIG. 160), ashereinafter further described. The articulation cables 1256A, 1256B,1256C and 1256D typically extend from the interior of the operator 1240through four cable openings 1257 to fixed attachment to the respectiveyoke arms 422B of the universal joint yoke 422, as further illustratedin FIGS. 159 and 160. A pair of spaced-apart, parallel yoke brackets422C extend from two of the yoke arms 422B of the universal joint yoke422 and are secured to the swing plate 424 by means of a yoke swivel pin422A to facilitate up-and-down articulation of the disc body 410 withrespect to the operator 1240. Accordingly, referring again to FIG. 160of the drawings the disc body 410 of the planetary wheel/gear device 400can be articulated in any desired direction by manipulation of therespective crescent angle articulation cables 1256A, 1256B, 1256C and1256D and manually rotating the operator 1240 along its longitudinalaxis, as hereinafter further described. As further illustrated in FIG.160 a frame 420C extends from fixed attachment to the universal jointyoke 422 to the disc bottom 410A for securing the universal joint yoke422 to the disc body 410.

Referring now to FIGS. 161-164 of the drawings and as described above,the conical central gear 415 has a central gear shaft 415A extendingdownwardly from the bottom thereof through a gear shaft opening 415Gprovided in the disc body bottom 410A (FIG. 162) and fitted with acentral bevel gear 415C that meshes with the corresponding drive shaftbevel gear 420B secured to the flexible drive shaft 420, as illustratedin FIGS. 161 and 162. As further illustrated in FIGS. 161 and 162 acentral gear tension spring 415D is interposed between the disc bodybottom 410A and the flat top segment of the central bevel gear 415C forexerting a downward force on the conical central gear 415 and engagingits textured or toothed driving surface 415F with the correspondingrespective sloping or beveled, textured or toothed rotor surfaces 417 ofthe toothed rotors 416. This facility insures that rotation of theconical central gear 415 responsive to operation of the flexible driveshaft 420 also causes the respective toothed rotors 416 to rotate andengage the needle 50 and drive the needle 50 around the fixed way 404,as illustrated in FIG. 163 and hereinafter further described. It will beappreciated that the conical central gear 415 can also be biaseddownwardly against the respective toothed rotors 416 by means ofalternative spring configurations such as a spring washer, innon-exclusive particular, as illustrated in FIG. 166 of the drawings, toachieve the same result.

Referring now to FIG. 165 of the drawings in an alternative preferredembodiment of the planetary wheel/gear device 400, an alternativecentral gear 414 is illustrated, having a doubled beveled edge 414A thatcontacts multiple alternative concave rotors 416C, having concavesurfaces 416CC, shaped to match the double beveled edge 414A of thealternative central gear 414. As in the case of the embodimentillustrated in FIGS. 159-164, a central gear tension spring 415D may beinterposed between the central bevel gear 415C, mounted on the centralgear shaft 415A, extending through the gear shaft opening 415G in thedisc bottom 410A. The disc body bottom 410A of the crescent disc body410 forces the alternative central gear 414 downwardly as indicated,against the respective alternative concave rollers 416C. Alternatively,as illustrated in FIG. 166, a spring washer 415E can be used to achievethe same result by substituting for the central gear tension spring415D. Accordingly, as further illustrated in FIG. 165, driving rotationof the alternative central gear 414 in the manner described above withrespect to the embodiments illustrated in FIGS. 159-164 also causesrotation of the respective alternate concave rotors 416C. Since thealternate concave rotors 416C also contact the needle 50, the needle 50is also caused to traverse the fixed way 404 in the crescent disc body410 in a direction determined by the direction of rotation of thecentral bevel gear 415C.

In a similar manner, referring again to FIG. 166 of the drawings theconical central gear 415 illustrated in FIGS. 159-166 of the drawingscan be rotatably fitted in the crescent disc body 410. Alternate toothedrotors 416B are also rotatably seated in the crescent disc body 410,each of which alternate toothed rotors 416B have a concave,outwardly-flaring bottom surface 416BB and a beveled top surface 416BX,the former of which contact the needle 50 in driving relationship andthe latter of which engage the conical central gear 415, to facilitaterotation of each of the alternate toothed rotors 416B. Engagementbetween the beveled driving surfaces 415F of the conical central gear415, mounted on the central gear shaft 415A, extending through the gearshaft opening 415G in the disc bottom 410A, and the correspondingbeveled top surfaces 416BX of the alternate toothed rotors 416B bydownward pressure is insured by operation of an alternate spring washer415E, interposed between the central bevel gear 415C and the disc bodybottom 410A, as illustrated. Alternatively, as heretofore described, thealternate spring washer 415E can be replaced by a central gear tensionspring 415D, as illustrated in FIG. 165, to perform the same function.

In operation and referring again to FIGS. 159-165 of the drawings theplanetary wheel/gear device 400 is utilized by initially positioningneedle 50 in the fixed way 404, and orienting the gap 405 (FIG. 160)such that the needle 50 can traverse the fixed way 404 in a 360-degreerotation, typically in the counterclockwise direction as indicated bythe needle direction arrows 428 in FIG. 163, and suture a material 100as illustrated in FIG. 164. Driving of the needle 50 in thecounterclockwise direction as illustrated in FIGS. 163 and 164 iseffected by connecting a suitable motor (not illustrated) to theflexible drive shaft 420 (FIG. 161) and rotating the flexible driveshaft 420 in the counterclockwise direction. This action causes thecentral bevel gear 415C to operate in the clockwise direction and drivethe conical central gear 415 in the clockwise direction and the toothedrotors 416 in the counterclockwise direction as indicated by therespective gear arrows 428A and 428B, respectively (FIG. 163), to effectcorresponding counterclockwise rotation of the needle 50, which ismaintained in place by the fixed way overhang 419. Since the conicalcentral gear 415 is spring-loaded downwardly to engage the respectivetoothed rotors 416, positive driving of the toothed rotors 416 iseffected by engagement between the textured or toothed driving surface415F of the conical central gear 415 and the corresponding respectivebeveled or sloping, textured or toothed rotor surfaces 417 of thecorresponding toothed rotors 416, as illustrated in FIG. 162. It will beappreciated by those skilled in the art that the respective engagingdriving surface 415F and corresponding rotor surfaces 417 can betextured with a friction enhancing material or can be splined or fittedwith teeth, as desired, to facilitate the desired frictional or engagingcontact therebetween and effect positive driving of the toothed rotors416 by operation of the conical central gear 415. Since the respectiveconical holes 416A extend into the fixed way 404, the toothed rotors 416extend into the inside surface of the fixed way 404 and thecorresponding sloping rotor surfaces 417 also engage the needle 50 andcause the needle 50 (oriented in the fixed way 404 for a selecteddirection of rotation) to traverse the fixed way 404 in the direction ofrotation of the toothed rotors 416.

It will be appreciated from a consideration of FIGS. 159 and 160 of thedrawings that the crescent disc body 410 can be manipulated intosubstantially any desired configuration such that the gap 405 (FIG. 164)accommodates the material 100 to be sutured, as further illustrated inFIG. 164, by articulation with respect to the operator 1240 illustratedin FIG. 160. This articulation is effected by manipulation of therespective crescent angle articulation cables 1256A, 1256B, 1256C and1256D, which project through the corresponding cable openings 1257 andtypically connect to a lever mechanism and lever 1251 as described in anearlier embodiment of the invention illustrated in FIGS. 1, 58, 62 and63. Accordingly, selectively applying tension to the crescent anglearticulation cable 1256A using the lever 1251 causes the crescent discbody 410 to rotate to the left on the swing plate pin 424A, whiletension in the oppositely-disposed crescent angle articulation cable1256C causes the opposite movement of the crescent disc body 410.Similarly, tensioning of the crescent angle articulation cable 1256B bymanipulating the lever 1251 causes the crescent disc body 410 to moveupwardly as it pivots on the yoke swivel pin 422A and tension applied tothe crescent angle articulation cable 1256D moves the crescent disc body410 in the opposite direction or downwardly, to maintain the necessaryclose positioning between the material 100 to be sutured and the discbody 410 as further illustrated in FIG. 164.

Referring now to FIG. 165 of the drawings, as heretofore described,rotation of the alternative central gear 414 in desired directiondetermined by the orientation of the needle 50 in the fixed way 404) bydriving of the central bevel gear 415C produces a corresponding rotationof the alternate concave rotors 416C in the opposite direction to drivethe needle 50 in that opposite direction. In like manner, referring toFIG. 166 of the drawings rotation of the conical central gear 415 in aselected direction imparts rotation of the respective alternate toothedrotors 416B in the opposite direction to drive the needle 50 in thatopposite direction in the manner and for the purpose described above.

It will be appreciated by those skilled in the art that the articulationfeature of the planetary wheel/gear device 400 illustrated in FIGS.159-160 is illustrative, it being understood that substantially anyarticulation operator, including the ball and joint articulationdescribed heretofore with respect to other embodiments of thisinvention, can be employed to operate the planetary wheel/gear device400. Other articulation techniques known to those skilled in the art maybe employed in the planetary wheel/gear device 400 as desired, tofacilitate articulation of the disc body 410 with respect to a material100 for suturing the material 100 as illustrated in FIG. 164 of thedrawings.

A still further embodiment of the cycling suturing and knot-tying deviceof this invention includes a flexible rotor device 500, illustrated inFIGS. 167-176 of the drawings. Referring initially to FIGS. 167 and 168of the drawings the flexible rotor device 500 includes an arcuate fixedway 504 having conical entry guides 504A on each open end thereof facingthe gap 505 between the open ends of the fixed way 504. The fixed way504 is provided in a disc 510 having a disc wall 509 and a fixed wayouter wall 512, provided in the fixed way 504 to receive the arcuateneedle 50, as illustrated in FIGS. 170, 170A and 170B. A protectiveplate 510A is typically secured on the disc 510 by means of a pair ofpins 510C that extend through the corresponding protective plateattachment holes 511A and are seated in the underlying wall holes 5101Bof a depression forming wall 511, as illustrated in FIG. 170. As furtherillustrated in FIGS. 168 and 170 the disc bottom 508 of the disc 510 isprovided with a bottom opening 508A. Furthermore, an inwardly-facingwall center section groove 515E is provided on the depression formingwall 511 and the wall center section groove 515E is bounded by a pair ofparallel wall shoulders 515F that extend outwardly of the plane of thewall center section groove 515E, as further illustrated in FIGS.168-170A and 174.

Referring again to FIGS. 167 and 168 of the drawings a flexible rotor515 includes a flexible outer band 51 SA, with flexible spokes 5151Bextending from the flexible outer band 515A inwardly in a spiral patternto a rotor shaft opening 516A. As further illustrated in FIGS. 173 and174 the flexible outer band 515A of the flexible rotor 515 includes acurved rotor contact area 515C, bounded by parallel, extending rotorshoulders 515D, which rotor shoulders 515D contact the correspondingwall shoulders 515F of the depression forming wall 511 as the flexiblerotor 515 rotates inside the disc 510, as further illustrated in FIG.174. Accordingly, in a preferred embodiment of this aspect of theinvention the rotor shoulders 515D and the corresponding wall shoulders515F are provided with a smooth surface treatment such as teflon or thelike, which is self-lubricating and causes minimum resistance torotation of the flexible rotor 515 in the disc 510. Furthermore, inanother preferred embodiment of the invention the rotor contact area515C is provided with an abrasive or textured material for securely, yetreleasably, engaging the needle 50 and driving the needle 50 around thefixed way 504 responsive to rotation of the flexible rotor 515, asillustrated in FIGS. 173 and 174 of the drawings.

Referring now to FIGS. 170A, 170B, 171 and 172 of the drawings it willbe appreciated by those skilled in the art that the flexible rotor 515can be placed in the disc 510 for either counterclockwise rotation (FIG.171) or clockwise (FIG. 172) rotation. As illustrated in FIG. 170B theflexible rotor 515 is positioned in the disc 510 for counterclockwiserotation in the direction of the arrow and the needle 50 is in positionfor counterclockwise rotation in the fixed way 504, with a length ofthread 50A typically attached to the center point of the needle 50, asindicated. Accordingly, it will be appreciated from a consideration ofFIG. 170B that counterclockwise rotation of the flexible rotor 515inside the disc 510 by a driving mechanism hereinafter described causesthe needle 50 to traverse the fixed way 504, as well as the gap 505illustrated in FIG. 167, in the same direction. As in the otherembodiments of the invention wherein the thread 50A is attached to anapproximate center point of the arcuate needle 50, the thread 50Afollows the needle rotation for suturing as hereinafter furtherdescribed. Furthermore, referring now to FIGS. 170 and again to 170B,when the protective plate 510A is secured on the disc 510, typically bymeans of the pins 510C, sufficient space is provided between theperiphery or perimeter of the protective plate 510A and the fixed wayouter wall 512 to allow clearance for the thread 50A to traverse theentire curved length of the disc 510.

Driving of the flexible rotor device 500 may be accomplished by any oneof several devices and techniques, typically as illustrated in FIG. 173,where the rotor shaft 516 is inserted through the rotor shaft opening516A of the flexible rotor 515 and through the bottom opening 508A ofthe disc 510, as illustrated in FIGS. 173 and 174. A cap 516E istypically provided on the top end of the rotor shaft 516 to retain therotor shaft 516 in place. In one drive embodiment a shaft bevel gear516B may be attached to or shaped integrally with the opposite end ofthe rotor shaft 516 from the shaft cap 516E, for engagement with acorresponding drive bevel gear 516C, having a drive bevel gear shaft516D attached to a source of power, indicated by the letter “P”, asillustrated in FIG. 174. This source of power can typically be a drivemotor of substantially the same design as the conventional micromotor48B illustrated in FIG. 109A of the drawings or the like, according tothe knowledge of those skilled in the art.

Another drive technique for operating the flexible rotor device 500includes a direct drive such as that illustrated in FIG. 176, wherein aflexible pinion gear shaft 48H is typically rotatably provided in aflexible housing tube 49 and attached to a drive mechanism such as theconventional micromotor 48B illustrated in FIG. 109A of the drawings.The opposite end of the pinion gear shaft 48H is attached directly tothe rotor shaft 516 as illustrated in FIG. 176, to drive the flexiblerotor 515 in either the clockwise or counterclockwise direction, asdesired, by selective positioning of the flexible rotor 515 in the disk510 and corresponding operation of the motor.

Referring now to FIG. 175 of the drawings in yet another drive mechanismfor operating the flexible rotor device 500, the rotor shaft 516 isconnected to a spindle 519 in a rotary cable circuit 518 that connectsthe spindle 519 to a drive spindle 519A, rotatably mounted between apair of mount blocks 525. An endless belt or cable 521 is wound on thespindle 519 and the drive spindle 519A and a ratchet 520 and a ratchetpawl 520A are provided on the bottom end of the spindle 519 tofacilitate driving of the spindle 519 in one direction and preventingreverse rotation of the spindle 519. A spindle bevel gear 524 isprovided on the bottom of the drive spindle 519A and the spindle bevelgear 524 engages a drive bevel gear 524A, connected to the shaft of amotor 523. Accordingly, operation of the motor 523 causes the drivebevel gear 524A and the spindle bevel gear 524 to rotate, therebyrotating the drive spindle 519A and, through operation of the endlesscable 521, the spindle 519 also rotates, to effect a correspondingrotation of the flexible rotor 515 and the needle 50 in the disc 510 ofthe flexible rotor device 500. The motor 23 can be typically equippedwith a rotation counter 526 for tracking the number of suturing cyclesof the needle 50 and a cutoff switch 527 and a reversal switch 528 mayalso be provided in a rotary cable circuit 529. It will be understood bythose skilled in the art that other operating mechanisms known to thoseskilled in the art may be used to effect rotation of the flexible rotor515 and the needle 50 in the flexible rotor device 500, as desired. Itwill be further appreciated from a consideration of FIG. 175 that therotary cable circuit 518 can be housed in a suitable operator such asthe operator described in other embodiments of this invention, asdesired.

Referring again to FIG. 176 of the drawings it will be furtherappreciated by those skilled in the art that the support or operator 531can be designed in the manner detailed and described above with respectto other embodiments of this invention and may include a universalcoupling, such as the universal joint yoke 422 illustrated in FIGS. 159and 160 of the drawings and as described with respect to those drawings.Other universal joint features known to those skilled in the art may beutilized to facilitate articulation of the disc 510 with respect to thesupport or operator 531 illustrated in FIG. 176 of the drawings.

It will be appreciated by those skilled in the art that the flexiblerotor device 500 illustrated in FIGS. 167-176 of the drawings and asdescribed above facilitates a simple, yet efficient, technique foreffecting rotation of the arcuate needle 50 around the fixed way 504 ineither the counterclockwise or clockwise direction, depending upon theorientation of the flexible rotor 515 in the disc 510. Various drivetechniques can be utilized as described and illustrated to effect thisrotation and a suitable operator can be attached to the disc 510 in anyconvenient fashion, as heretofore described.

In another embodiment of the cycling suturing and knot-tying device ofthis invention a pawl and crank device is illustrated in FIGS. 177-188.The pawl and crank device is generally illustrated by reference numeral600 and as illustrated in FIGS. 177-178, includes an arcuate disc 610,open along one segment to define a disc gap 605 (FIG. 177A) andincluding a fixed way or groove 604 that flares at each end thereof at afixed way bevel 604A to accommodate a curved needle 50. The needle 50 issharpened at both ends which define a needle gap 605A therebetween,which needle gap 605A is slightly more narrow than the disc cap 605 inthe disc 610, as further illustrated in FIG. 177A. The disc 610 includesa removable disc cover 611 (FIG. 177A) and a disc bottom 610A whichfacilitate enclosure of a pawl 618 and a cooperating crank 622 andconnecting crank pin 622A, illustrated in FIGS. 177B and 178. As furtherillustrated in FIGS. 177 and 177A, a length of thread 50A has one endconnected to the approximate center point of the curved needle 50 andthe needle thread 50A is allowed to traverse the disc gap 605 and thespace between the perimeter of the disc cover 611 and the fixed way orgroove 604 of the disc 610. This continuous opening in the disc 610facilitates uninhibited movement of the thread 50A throughout the lengthof the disc 610 responsive to incrementation of the needle 50 byrotation of the pawl 618, as hereinafter further described.

The disc 610 is typically connected to an articulating joint 633 asfurther illustrated in FIG. 177 to facilitate articulation of the disc610 with respect to an operating arm 634, also connected to thearticulating joint 633. In a preferred embodiment of the invention theoperating arm 634 is attached to a vertical pin bracket 633D, pivotallyconnected to, a horizontal motion bracket 633B by means of a verticalpin 633E. This connection facilitates horizontal rotation of thehorizontal motion bracket 633B and the fixed joint bracket 633A to whichit is attached, on the vertical pin 633E, which fixed joint bracket 633Ais, in turn, typically connected to the disc 610 by means of shaftsupport plate 632A. Vertical movement of the disc 610 with respect tothe operating arm 634 is effected by means of a horizontal pin 633C thatextends through the fixed joint bracket 633A and the horizontal motionbracket 633B. A shaft support bearing 632B is welded or otherwiseattached to the shaft support plate 632A and serves to journal one endof a flexible bevel gear shaft 631 for rotation in the shaft supportbearing 632B. A drive bevel gear 631A is attached to the extending endof the flexible bevel gear shaft 631, which projects through a bevelgear shaft support 632, the shaft support plate 632A and through theshaft bearing 632B to facilitate rotation of the drive bevel gear 631A,as well as a pivot pin bevel gear 631B, meshed therewith, as furtherillustrated in FIG. 177. The drive pin bevel gear 631B is fixed to thedrive pin 625 for rotating the crank 622 and the crank pin 622A andincrementing the pawl 618, as illustrated in FIG. 177B and hereinafterdescribed. A brace 632C extends from the shaft support bearing 632B tofixed connection to the disc bottom 610A to better support—the disc 610on the fixed joint bracket 633A. Accordingly, from consideration of FIG.177 it will be appreciated that manipulation of the disc 610 and thusthe disc gap 605, with respect to a material to be sutured (notillustrated) can be effected by movement of the operating arm 634 andimplementing the articulating joint 633, since the flexible bevel gearshaft 631 will bend to accommodate the desired movement in the disc 610.

Referring again to FIGS. 177A-177D of the drawings it will beappreciated that the disc cover 611 is typically removably secured tothe disc 610 by means of an attachment screw 620B as the disc cover 611fits on the disc 610 along the inside periphery of the needle 50 and isstabilized in place on the arcuate cover support plate 611A that definesthe disc gap 605 illustrated in FIG. 177A. A threaded attachment screw620B (FIG. 177A) is typically threaded into the internally-threaded hole620A in the pivot pin cap element 620C of the pivot pin 620, asillustrated in FIGS. 177A and 177C. The pivot pin 620 is fixed to thedisc cover 611 by means of a pivot pin shaft 620D that supports thepivot pin cap 620C, as further illustrated in FIGS. 177C and 177D.

Referring again to FIGS. 177C, 177D, and 178 a crank pin opening 622Baccommodates the drive pin 625, illustrated in FIGS. 177B and 177C, tofacilitate rotation of the crank 622 and the crank pin 622A responsiveto operation of the intermeshed drive bevel gear 631A and pivot pinbevel gear 6311B, as hereinafter further described. Accordingly, asfurther illustrated in FIGS. 177B, 177C, 177D and 178, the pawl 618 isinstalled in the disc 610 such that the pivot pin shaft 620D, projectingupwardly from fixed attachment to the disc bottom 610A as illustrated inFIGS. 177C and 177D, extends through an elongated pivot pin slot 619provided in the pawl leg 618B of the pawl 618. The pivot pin cap 620C ispositioned such that the attachment screw 620B can be used to secure thedisc cover 611 removably on the disc 610 by threadable seating in thethreaded hole 620A. Furthermore, as illustrated in FIG. 178 the crankpin 622A, fixed to the crank 622, projects through the chevron cam slot630 provided in the pawl 618, to facilitate traversal of the crank pin622A along the periphery of the chevron cam slot 630 and driving of thepawl 618 inside the disc 610 responsive to rotation of the crank 622, ashereinafter further described. As further illustrated in FIG. 177B thecrank 622 has sufficient 360-degree rotational space to operate, byprovision of the crank operating opening 618C, provided in the oppositesurface of the pawl 618 from the chevron cam slot 63Q. The curved uppersurface of the pawl 618 is provided with pawl teeth 618A, which paralleland match the curvature of the fixed way or groove 604, as furtherillustrated in FIG. 178. Furthermore, the chevron cam slot 630 providedin the pawl 618 is characterized by a counterclockwise needle side slotwall 630A, a clockwise needle side slot wall 630B, a counterclockwisepivot side slot wall 630C and a clockwise pivot side slot wall 630D.Accordingly, when the crank pin 622A is caused to traverse the chevroncam slot 630 by alternate counterclockwise and clockwise rotation of thecrank 622, the crank pin 622A exerts force on each of thecounterclockwise needle side slot wall 630A, the clockwise needle sideslot wall 630B, the counterclockwise pivot side slot wall 630C and theclockwise pivot side slot wall 630D in the sequences hereinafterdescribed. These actions facilitate sequential clockwise andcounterclockwise incrementation of the pawl 618 inside the disc 610 asthe pawl teeth 618A sequentially engage and disengage the softer needle50 to drive the needle 50 in either the clockwise or counterclockwisedirection, depending upon the direction of rotation of the crank 622, asfurther hereinafter described.

In operation and referring now to FIGS. 177A and 178-183 of the drawingsand initially to FIGS. 177A and 178, the needle 50 is first positionedin the curved fixed way or groove 604 as illustrated in FIG. 177A andthe disc cover 611 is fitted into place and secured by means of theattachment screw 620B. The clearance between the perimeter of the disccover 611 and the overhang 616 which extends the disc outer wall 614 ofthe disc 610, allows the needle 50 free rotational movement within thecurved fixed way or groove 604, but will not allow the needle 50 to exitthe fixed way or groove 604 from the top. As further illustrated in FIG.178 the pawl 618 is fitted inside the disc 610 such that the pawl teeth618A are caused to sequentially engage the needle 50 and disengage theneedle 50, depending upon pressure exerted by the rotating crank pin622A, since the elongated pivot pin slot 619 that receives the pivot pinshaft 620D facilitates movement of the pawl 618 to and from the needle50 resulting from that pressure. Accordingly, as further illustrated inFIG. 178 the crank pin 622A is shown at the end of a power stroke inwhich the pawl 618 has been in contact with the needle 50 and rotatedthe needle 50 in the counterclockwise direction. The crank pin 622A isnow caused to rotate in the counterclockwise direction as indicated bythe arrow superimposed on the crank pin 622A in the chevron cam slot630, by operation of a power source (not illustrated) that rotates theflexible bevel gear shaft 631 and thus, the drive bevel gear 631 A, thedrive pin bevel gear 631B and the drive pin 625 to effect correspondingrotation of the crank 622 and the crank pin 622A. This movement of thecrank pin 622A in the direction of the arrow illustrated in FIG. 178causes the crank pin 622A to contact the counterclockwise pivot sideslot wall 630C, producing inward movement of the pawl 618 away fromcontact with the needle 50, as illustrated by the arrow located at thebase of the chevron cam slot 630. This action of the crank 622 and thecrank pin 622A also effects a clockwise movement of the pawl 618 asfurther illustrated by the curved arrow below the pawl teeth 618.

As illustrated in FIG. 179 continued rotation of the crank 622 and thecrank pin 622A in the counterclockwise direction as indicated by thearrow on the crank pin 622A exerts a continuing force on thecounterclockwise pivot side slot wall 630C near the bottom of thechevron cam slot 630, to effect additional clockwise rotation of thepawl 618 in the direction of the curved arrow located beneath the pawlteeth 618A. At this point the crank pin 622A is nearing the distal endof its circular orbit and this movement of the crank pin 622A moves thepawl teeth 618A even further away from the needle 50 in the direction ofthe arrow at the base of the chevron cam slot 630.

Referring now to FIG. 180 the crank pin 622A is still in contact withthe counterclockwise pivot side slot wall 630C as the crank 622 and thecrank pin 622A continue to rotate in the counterclockwise direction asillustrated by the arrow superimposed on the crank pin 622A in thechevron cam slot 630. The crank pin 622A is now on the proximal side ofits circular orbit and is moving distally as it continues to rotate inthe counterclockwise direction to continue movement of the pawl 618 inthe clockwise direction, as illustrated by the curved arrow beneath thepawl teeth 618A, while still applying an inward or downward force asillustrated by the arrow located beneath the base of the chevron camslot 30. In this configuration of the crank pin 622A and the pawl 618,the pawl teeth 618A remain out of contact with the needle 50 due to thedownward movement of the pawl 618 facilitated by the pivot pin slot 619.

As illustrated in FIG. 181 of the drawings the crank 622 and the crankpin 622A continue in a counterclockwise rotation as indicated by thearrow superimposed on the crank pin 622A and the crank pin 622A has nowcontacted the counterclockwise needle side slot wall 630A of the chevroncam slot 630, which action drives the pawl 618 upwardly in the directionof the arrow beneath the base of the chevron cam slot 630, to force thepawl teeth 618A in contact with the needle 50 (not illustrated).Continued pressure exerted on the counterclockwise needle side slot wall630A of the chevron cam slot 630 by the crank pin 622A also causes thepawl 618 and the needle 50 to move in the counterclockwise direction asindicated by the arrow beneath the pawl teeth 618A and since the pawlteeth 618A are now firmly seated on the needle 50, the needle 50 is alsocaused to move around the fixed way or groove 604 in thecounterclockwise direction.

Referring now to FIG. 182 of the drawings continued rotation of thecrank 622 and the crank pin 622A in the counterclockwise direction asindicated, causes additional pressure to be exerted on thecounterclockwise needle side slot wall 630A of the chevron cam slot 630to continue the upward force exerted by the pawl teeth 618A against theneedle 50 and counterclockwise rotation of both the pawl 618 and theneedle 50 as indicated by the arrows, respectively.

As illustrated in FIG. 183 of the drawings the crank 622 and crank pin622A have continued to move in the counterclockwise direction and extendthe crank pin 622A to the distal end of its circular orbit, thusmomentarily bringing the pawl 618 to a stop, as illustrated by theposition of the crank pin 622A in the base of the chevron cam slot 630.

Referring to FIGS. 177 and 184, under circumstances where the crank 622and the crank pin 622A are caused to rotate in the clockwise directionby reverse operation of the respective drive pin 625, the flexible bevelgear shaft 631, the drive bevel gear 631A and the pivot pin bevel gear631B illustrated in FIG. 177, pressure is initially exerted against theclockwise needle side slot wall 630B of the chevron cam slot 630 by thecrank pin 622A in the direction of the arrow superimposed thereon, asillustrated in FIG. 184. This action forces the pawl 618 upwardly asindicated by the arrow at the base of the chevron cam slot 630, intocontact with the needle 50 such that the pawl teeth 618 engage theneedle 50 in driving relationship. The force supplied by the crank pin622A against the clockwise needle side slot wall 630B in this mode ofoperation also forces the pawl 618 and the needle 50 to rotate in theclockwise direction, as indicated by the arrow located beneath the pawlteeth 618A.

As illustrated in FIG. 185 as the crank 622 and crank pin 622A continueto rotate in the clockwise direction as indicated by the arrowsuperimposed on the crank pin 622A, as continued pressure is exertedagainst the clockwise needle side slot wall 630B and jointly continue toforce the pawl teeth 618A against the needle 50 and cause the pawl 618and the needle 50 to rotate in the clockwise direction, as indicated bythe indicated arrows. Accordingly, the pawl 618 and the needle 50 rotatein concert in the clockwise direction around the inner periphery of thedisc 610, with the needle following the fixed way or groove 604.

Referring to FIG. 186, as the crank 622 and the crank pin 622A begin thelast quarter of travel in the distal direction in clockwise rotation,the crank pin 622A contacts the clockwise pivot side slot wall 630D ofthe chevron cam slot 630 and applies pressure to begin moving the pawl618 inwardly in the direction of the arrow beneath the base of thechevron cam slot 630 and disengage the pawl teeth 618A from the needle50, causing the pawl 618 to move in the counterclockwise direction, asindicated by the arrow beneath the pawl teeth 618A.

FIG. 187 illustrates continued movement of the crank 622 and the crankpin 622A in the clockwise direction as indicated by the arrowsuperimposed thereon, to exert pressure on the clockwise pivot side slotwall 630D of the chevron cam slot 630 and move the pawl 618 inwardly andin the counterclockwise direction without contacting the needle 50, asindicated.

As illustrated in FIG. 188 the crank 622 and crank pin 622A continue torotate in the clockwise direction in the chevron cam slot 630 asindicated by the arrow, to approach contact with the clockwise needleside slot wall 630B, where it will begin another clockwiseincrementation of the pawl 618 and drive the needle 50 in the fixed wayor groove 604.

It will be appreciated from a consideration of the drawings thatselected counterclockwise and clockwise rotation of the crank 622 andthe crank pin 622A responsive to corresponding operation of the engageddrive bevel gear 631A and pivot pin bevel gear 631B, effectsincrementing of the pawl 618 and driving of the needle 50 in theopposite clockwise or counterclockwise direction in the fixed way orgroove 604 of the disc 610. Accordingly, continued rotation of the crank622 in the same direction releases the pawl 618 from the needle 50 andfacilitates reincrementing of the pawl 618 in the opposite direction foradditional contact with, and driving of the needle 50 in the firstdirection. It will be further appreciated from a consideration of FIGS.178-188 of the drawings that the needle 50 is thusly caused tocompletely traverse the fixed way or groove 604 of the disc 610 ineither direction and to periodically traverse the disc gap 605 to suturetissue extending in the disc gap 605 and the needle gap 605A, asillustrated in FIG. 177A. Furthermore, since the thread 50A has a clearpath to rotate throughout the curved length of the disc 610 in theopening defined by the disc cover 611 and the overhang 616 of the discouter wall 614, it will be carried through the material sutured in thedisc gap 605 as the needle 50 penetrates that material in the suturingoperation.

The pawl and crank device 600 is characterized by convenience, ease ofoperation and easy cleaning, in that the cover 611 can be quickly andeasily removed from the disc 610 by removing the attachment screw 620Bfrom the underlying pivot pin cap 620C to facilitate access to the pawl618 and the chevron cam slot 630, as well as the other operating andfixed elements of the device. Furthermore, it will be appreciated bythose skilled in the art that the pawl and crank device 600 can bedesigned to facilitate removal of operating elements such as the pivotpin 620 and thus the pawl 618, from the interior of the disc 610 anddisassembly of the drive train, including the drive bevel gear 631A andthe pivot pin bevel gear 631B, as well as the other components of thedrive system, as desired. Moreover, it will be further appreciated bythose skilled in the art that the articulating joint 633 illustrated inFIG. 177 is exemplary, it being possible to provide other articulatingdesigns, such as the operator 1240, illustrated in FIG. 160, which areequally effective in manipulating and articulating the disc 610 withrespect to the operating arm 634 of the device.

It will be further appreciated by those skilled in the art that althougha single pawl is shown in this embodiment of the invention, a system ofpawls can be utilized to enhance certain characteristics of the device.For example, a shorter throw at each of the multiple pawl movements andnarrower pawl profiles, together with shorter crank pin offsetparameters can make possible multiple pawl arrangements which expand thepawl contact area with the needle. Additional pawls can also serve tofacilitate placement of the needle-engaging teeth closer to the ends ofthe fixed way or groove. Each additional pawl can typically be driven bya separate crank shaft and pin and independent shafts or a centralplanetary gear arrangement can be utilized to power such mechanicalconfigurations. Alternatively, piezo electrical elements grouped in anappropriate manner, can also be utilized under application of electriccurrent to advance the pawl or pawls by expanding in length with a forcesufficient to act upon the pawl or pawls, thus producing a mechanicallymultiplied force to the outer curvature of the pawl teeth against theneedle. It will also be appreciated by those skilled in the art thatpower transmission to the bevel gears and thus to the pawl or pawls, canbe provided by any one of several mechanisms known to those skilled inthe art.

It is understood that various materials of construction known to thoseskilled in the art can be used in the respective components and parts ofthe above embodiments. Among these are metal and plastic (e.g. variousblades, cases, housings, enclosures), silicon-coated parts (e.g., bladesand needle tips, cases, housings, enclosures) and the like.

It is also understood that the device of this invention, in any or allof the above described embodiments, can be used in sewing applicationsother than suturing, including sewing of cloth, canvas, plasticmaterials, sheet metal and the like, in non-exclusive particular.

Turning to FIGS. 189 through 198 of the drawings an alternate embodimentof the cycling suturing and knot-tying device of this invention is thereillustrated and generally identified by the numeral 1400. Thisembodiment is similar in some respects to the embodiments described inU.S. Ser. No. 10/263,902, but includes several improvements the natureof which will be discussed in the paragraphs which will follow. U.S.Ser. No. 10/263,902 was published on May 1, 2003 as US 2003/0083674 A1.Because of its pertinence Publication 2003/0083674 A1 is herebyincorporated by reference as though fully set forth herein. Referringparticularly to FIG. 189 of the drawings, device 1400 can be seen tocomprise a gripping portion 1402 comprising a generally pistol shapedhandgrip 1404 and a trigger mechanism 1406 connected to the handgrip inthe manner shown in FIGS. 190 and 191. Trigger mechanism 1406 comprisesa part of the novel operating means of the invention, the character ofwhich will presently be described.

Connected to gripping portion 1402 is an elongated, hollow barrelportion 1408, and connected to the hollow barrel portion by connectormeans is an articulating, or multipositionable, suturing head portiongenerally designated by the numeral 1410. Multipositionable head portion1410, which comprises one of the improved features of this latest formof the invention, is of a novel design that includes a generallysemicircular-shaped body 1412 having a generally semicircular-shapedshuttle track 1413 (FIGS. 194 and 195). The connector means, hereprovided as a knurled, generally cylindrically shaped connector 1409functions to interconnect the head portion with the barrel portion inthe manner shown in FIGS. 189 and 195.

Operably associated with body 1412 is a generally semicircular-shapedshuttle member 1414 that is slidably movable by the operating means ofthe invention along the shuttle track between a first position shown inFIG. 194 and a second position shown in FIG. 195. As best seen in FIGS.196 and 197, shuttle member 1414, which has a first end 1414 a and asecond end 1414 b, is provided with a generally semicircular shapedneedle groove, or guide 1416 that extends from the first end of theshuttle member to the second end thereof. Uniquely, shuttle member 1414is also provided with a plurality of strategically shaped,circumferentially-spaced cavities 1420 the purpose of which will bedescribed in the paragraphs which follow.

Carried within a needle guide 1416 that is formed in shuttle member 1414is a highly novel, generally semicircular-shaped suturing needle 1422.Needle 1422, which can be constructed from metal or plastic, isincrementally movable along the needle guide from a first position shownin FIG. 194 to a second position shown in FIG. 195 and then to a thirdand subsequent further advanced positions. As best seen in FIG. 198,needle 1422, which has first and second ends 1422 a and 1422 b, is of aunique construction. Unlike most prior art suture needles, needle 1422,rather than being circular in cross-section, is generally rectangular incross-section and has upper and lower surfaces disposed within thegenerally parallel planes (See FIG. 198). The first end of the sutureneedle is tapered or chamfered at a precisely selected angle, while thesecond end thereof is provided with a pair of spaced-apart apertures1424 and 1426. These apertures, which receive the suture “S” extendgenerally perpendicular to the plane of the upper and lower surfaces ofthe needle. To compensate for the tendency of the needle to open up asit penetrates the tissue to be sutured, the point “S-1” of the needle isoff-center of the axis “A” of the arc of the needle (see FIG. 198).

As best seen in FIGS. 195 and 196, the first end 1414 a of shuttlemember 1414 is provided with a generally tapered or conically shapedopening 1428 for receiving the tapered end of the needle as the needleis incrementally advanced. The opening 1428 is strategically configuredso as to permit the tapered or chamfered end of the needle to deflectsomewhat as it is guided into the groove or guide 1416 formed in theshuttle member.

Considering now in greater detail the previously mentioned operatingmeans of this latest form of the invention, as will be understood fromthe discussion that follows, this novel operating means functions tocontrollably advance and retract the shuttle member 1414 along shuttletrack 1413 between its first and second positions. This sequentialmovement of the shuttle member, in turn, uniquely causes the suturingneedle 1422 to incrementally move smoothly along the needle guide fromits first position to its second position and then onto further advancedpositions within the shuttle head. In addition to the previouslymentioned trigger mechanism 1406, this important operating means alsocomprises first and second operating cables 1430 end 1432 which arestrategically entrained through hollow barrel portion 1408 in the mannerillustrated in FIGS. 190A, 190C, 191A and 192A. As seen in the drawings,operating cable 1430 has a first end 1430 a connected proximate thefirst end 1414 a of shuttle 1414 (see FIG. 202) and a second end 1430 bconnected to a coupling mechanism 1406 a or trigger mechanism 1406 (seeFIG. 190A). Similarly, second operating cable 1432 has a first end 1432a connected proximate second end 1414 b of shuttle 1414 and a second end1432 b connected to a return mechanism 1407 which includes a biasingmeans or return spring 1407 a that is connected to the gripping portion1402 (See FIG. 191A). The function of this biasing means will presentlybe discussed in greater detail.

With the construction described in the preceding paragraph, sequentialactuation and release of the trigger 1406 b of the trigger mechanism,will cause the shuttle to sequentially move along the shuttle trackbetween the first and second positions in the manner illustrated inFIGS. 194 and 195. More particularly, when the trigger 1406 b of thetrigger mechanism is actuated, the first operating cable 1430 will movethe shuttle 1414 in a clockwise direction from the first position shownin FIG. 194 to the second position shown in FIG. 195. As this occurs,the biasing means, or return spring 1407 a of the return mechanism 1407,which is connected to the reciprocally movable coupling mechanism 1406b, is extended as illustrated in FIG. 192A. In its extended position theextension spring acts upon the second operating cable 1432 tending toreturn it to its starting position and, in turn, tending to move theshuttle 1414 in a counterclockwise direction toward its startingposition. To return the trigger 1406 b to its starting positionfollowing trigger actuation a compressible coil spring 1406 c isprovided. Spring 1406 c, which comprises a part of the trigger mechanism1406, is compressed in the manner shown in FIG. 192A when the trigger isactuated and functions to return the trigger to its default, or startingposition shown in FIG. 191A, when pressure on the trigger is released.

In a manner now to be described, movement of the shuttle 1414 along theshuttle track 1413 causes concomitant, controlled movement of the sutureneedle 1422 along needle guide 1416. As previously mentioned, shuttlemember 1414 is provided with a plurality of strategically shaped,circumferentially spaced cavities 1420. Disposed within each of thesecavities 1420 is a uniquely configured needle engaging member 1440 (seeFIG. 199) that includes first and second, rounded ends 1440 a and 1440 band a needle receiving opening 1440 c for closely receiving the needle1422. Members 1440 are adapted for both transverse and pivotal movementwithin the cavity in response to movement of the 1414 shuttle betweenits first and second positions. This novel movement of the members 1440within the cavities 1420 is illustrated in FIGS. 200 and 201 of thedrawings. As shown in FIG. 200, also partially disposed within cavities1420 are biasing means, shown here as compressible and expandableelastomeric springs 1442, which act upon members 1440. Springs 1442,which are of a generally flat configuration are carried within smallercavities segments 1444 which communicate with larger cavities 1420 inthe manner illustrated in FIGS. 197, 200 and 201.

Turning particularly to FIG. 198, it is to be noted that suturing needle1422 is provided with a plurality of circumferentially spaced-apartnotches 1445, which are uniquely constructed and arranged to be engagedby the needle engaging members as the needle engaging members movewithin cavities 1420. More particularly, as the shuttle member 1414moves from the first position shown in FIG. 194 toward the secondposition shown in FIG. 195, the needle engaging members will engage theneedle in the manner illustrated in FIG. 200, causing the needle 1422 tomove along with the shuttle member and penetrate the tissue disposedwithin the head opening 1447. Unlike the prior art circular crosssection suturing needles, which provide only a point contact with aneedle driving member, the novel rectangular cross section needle of thepresent invention presents a substantially flat, grooved or notched wallthat provides a superior line contact with the driving member thatadvances the needle.

As indicated in FIG. 200, spring 1442 continuously urges the drivemembers into binding engagement with the needle. However, upon releaseof the trigger 1406 a, which permits the shuttle to return to itsstarting position due to the urging of the extension spring 1436, theneedle engaging members 1440 will compress the elastomeric springs 1442and will pivot and move transversely within cavities 1420 in thedirection of the arrows to engage the needle in the manner shown in FIG.201. With the needle engaging members in this position, the members willslide relative to the needle permitting the needle to remain in placewhen the trigger 1406 a is released and allowing the shuttle member 1414to move counterclockwise to the position illustrated in FIG. 194. Whenthe trigger 1406 b is once again actuated, the shuttle member 1414 willagain move in a clockwise direction as illustrated in FIG. 195 causingthe needle engaging members 1440 to once again grip the suturing needle1422 due to the urging of the elastomeric springs 1442. This gripping ofthe needle will again cause it to advance in a clockwise direction alongthe needle guide 1416 toward its third advanced position (not shown). Asthe process is repeated, the needle will continue to advance in aclockwise direction along the needle guide 1416 so that the suturing canbe controllably and efficiently completed.

As illustrated in FIGS. 194 195 and 196, body 1412 of the suturing headis also provided with a pair of strategically shaped, circumferentiallyspaced cavities 142 within which needle engaging members 1440 arehoused. These members cooperate with and function in an identical manneras the needle engaging members housed within the cavities formed in theshuttle 1414 to control the movement of the suturing needle within guideway 1416 as the shuttle moves along the shuttle track 1413. Moreparticularly, as the shuttle member 1414 moves from the first positionshown in FIG. 194 toward the second position shown in FIG. 195, theseneedle engaging members will engage the needle in the manner illustratedin FIG. 200, causing the needle 1422 to move with the shuttle member.However, upon release of the trigger 1406 a, which permits the shuttleto return to its starting position due to the urging of the extensionspring 1436, these needle engaging drive members will move into theneedle slip configuration shown in FIG. 201 permitting the needle toremain in its advanced position.

In using the suturing device of the present invention, with the suturinghead components in the position illustrated in FIG. 194 and with thetissue to be sutured disposed within open 1447, the suturing process isbegun by actuating the trigger 1406 b of the trigger mechanism. When thetrigger is actuated, the first operating cable 1430, which is connectedproximate the bottom of the first end of the shuttle 1414, (see FIG.202) will move the shuttle 1414 in a clockwise direction from the firstposition shown in FIG. 194 to the second position shown in FIG. 195. Asthe shuttle moves in this clockwise direction, cable 1432 will beforeshortened the direction of the arrow 1451 of FIG. 202 causing thereturn spring 1407 a to be extended in the manner shown in FIG. 192A.

During the clockwise movement of the shuttle, elastomeric springs 1442will urge spring engaging members 1440 into binding engagement with theneedle 1422 in the manner illustrated in FIG. 200 causing the needle,along with the suture “S”, to advance to the needle penetrating positionshown in FIG. 195. When the needle and the shuttle reaches this advancedposition, the shuttle 1414 will be urged to move in a counterclockwisedirection toward its starting position due to the urging of returnspring 1407 a. During this counterclockwise movement of the shuttlemembers, the needle engaging members 1440 will move within cavities 1420into the needle slip position illustrated in FIG. 201. This novelpivotal and transverse movement of the needle engaging members withintheir respective cavities will compress elastomeric springs 1442 andwill permit the needle 1422 to slip relative to the shuttle members andremain in the advanced position shown in FIG. 195.

After the shuttle members return to their starting positions, actuationof the trigger member 1406 a will once again cause clockwise movement ofthe shuttles along the shuttle track 1413. As before, during thisclockwise movement of the shuttle, elastomeric springs 1442 will urgespring engaging members 1440 into binding engagement with the needle1422 in the manner illustrated in FIG. 200 causing the needle and thesuture “S” to advance to a third, further advanced position (not shown).It is to be appreciated that by the repeated actuation and release ofthe trigger member 1406 a, the suturing needle can be smoothly incontrollably incrementally further advanced along the needle guide 1416to efficiently complete the suturing operation.

While the preferred embodiments of the invention have been describedabove, it will be recognized and understood that various modificationsmay be made in the invention and the appended claims are intended tocover all such modifications which may fall within the spirit and scopeof the invention.

1. A suturing device comprising: (a) a gripping portion; (b) a headportion operably associated with said gripping portion, said headportion comprising: (i) a body having a shuttle track; (ii) a shuttleoperably associated with said body for movement along said shuttle trackbetween a first position and a second position, said shuttle beingprovided with a needle guide and at least one cavity; (iii) a needlecarried by said shuttle for movement along said needle guide between afirst position and a second position; and (iv) a needle engaging membercarried in said at least one cavity for engagement with said needle tocontrol movement of said needle along said needle guide; and (c)operating means operably associated with said gripping portion formoving said shuttle between said first and second positions, saidoperating means comprising: (i) an advancing mechanism operablyassociated with said shuttle for moving said shuttle to said secondposition; (ii) a first operating cable having a first end connected tosaid shuttle and a second end connected to said advancing mechanism; and(iii) a return mechanism connected to said shuttle for automaticallymoving said shuttle to said first position.
 2. The suturing device asdefined in claim 1, further including a barrel portion connected to andextending from said gripping portion.
 3. The suturing device as definedin claim 2 in which said advancing mechanism includes a triggermechanism carried by said gripping portion.
 4. The suturing device asdefined in claim 3 in which said shuttle is provided with a plurality ofcircumferentially spaced cavities and further includes a needle engagingmember carried within each of said circumferentially spaced-apartcavities for transverse and pivotal movement within said cavities inresponse to movement of said shuttle between said first and secondpositions.
 5. The suturing device as defined in claim 4 in which saidneedle is semicircular in shape and is provided with a plurality ofcircumferentially spaced-apart notches that are so constructed andarranged as to be engaged by said needle engaging member as said needleengaging member moves within said cavities.
 6. The suturing device asdefined in claim 5 in which said needle is generally rectangular incross-section and has first and second ends, said first end beingtapered and said second end being apertured.
 7. The suturing device asdefined in claim 6 in which said shuttle has first and second ends, saidfirst end being provided with a tapered opening for receiving said firsttapered end of said needle.
 8. The suturing device as defined in claim 6further including connector means for connecting said head portion tosaid barrel portion to permit movement of said head portion relative tosaid barrel portion into a multiplicity of positions.
 9. A suturingdevice comprising: (a) a gripping portion comprising a handgrip and atrigger mechanism connected to said handgrip; (b) an elongated, hollowbarrel portion connected to said gripping portion; (c) amultipostionable head portion connected to said barrel portion, saidhead portion comprising: (i) a generally semicircular-shaped body havinga shuttle track; (ii) a generally semicircular-shaped shuttle operablyassociated with said generally semicircular-shaped body for movementalong said shuttle track from a first position to a second position andfrom said second position to a third advanced position, said shuttlehaving first and second ends and being provided with a generallysemicircular-shaped needle guide and a plurality of circumferentiallyspaced cavities; (iii) a generally semicircular-shaped needle carried bysaid shuttle for movement along said needle guide between a firstposition and a second position, said needle having first and second endssaid first end being tapered; and (iv) a needle engaging member carriedin each of said plurality of circumferentially spaced cavities forengagement with said needle to control movement of said needle alongsaid needle guide; and (d) operating means carried by said grippingportion and said barrel portion for controllably moving said shuttle,said operating means comprising: first and second operating cablescarried by said hollow barrel portion, said first operating cable havinga first end connected to said first end of said shuttle and a second endconnected to said trigger mechanism; a return mechanism connected tosaid shuttle for automatically moving said shuttle to said firstposition; and said second operating cable having a first end connectedto said second end of said shuttle and a second end connected to saidreturn mechanism.
 10. The suturing device as defined in claim 9 in whichsaid needle engaging member is movable both transversely and pivotallywithin said cavities.
 11. The suturing device as defined in claim 9further including biasing means carried within each of saidcircumferentially spaced-apart cavities and being operably associatedwith said needle engaging member for yieldably resisting movement ofsaid needle engaging drive members within said circumferentiallyspaced-apart cavities.
 12. The suturing device as defined in claim 11 inwhich said needle is provided with a multiplicity of circumferentiallyspaced-apart notches that are so constructed and arranged as to beengaged by said needle engaging member as said needle engaging membermoves within said cavities.
 13. The suturing device as defined in claim12 in which said needle is generally rectangular in cross-section. 14.The suturing device as defined in claim 13 in which said first end ofsaid shuttle is provided with a generally conically shaped opening forreceiving said chamfered end of said needle.
 15. The suturing device asdefined in claim 13 in which said needle has a generally planar surfacelying within a plane and in which said second end of said needle isprovided with the aperture extending generally perpendicular to saidplane to receive a suture.
 16. A suturing device comprising: (a) agripping portion comprising a handgrip and a trigger mechanism connectedto said handgrip; (b) an elongated, hollow barrel portion connected tosaid gripping portion; (c) an articulating head portion connected tosaid barrel portion, said articulating head portion having: (i) agenerally semicircular-shaped body having a shuttle track; (ii) agenerally semicircular-shaped shuttle operably associated with saidgenerally semicircular-shaped body for movement along said shuttle trackfrom a first position to a second position and from said second positionto a third advanced position, said shuttle having first and second endsand being provided with a generally semicircular-shaped needle guide anda plurality of circumferentially spaced cavities; (iii) a generallysemicircular-shaped needle carried by said shuttle for movement alongsaid needle guide between a first position and a second position, saidneedle having first and second ends said first end being chamfered; (iv)a needle engaging member carried in each of said plurality ofcircumferentially spaced cavities for engagement with said needle tocontrol movement of said needle along said needle guide, each saidneedle engaging member being movable both transversely and pivotallywithin said cavity; and (v) biasing means carried within each of saidcircumferentially spaced-apart cavities and being operably associatedwith said needle engaging member for yieldably resisting movement ofsaid needle engaging members within said circumferentially spaced-apartcavities; and (d) operating means carried by said gripping portion andsaid barrel portion for controllably moving said shuttle, said operatingmeans comprising: first and second operating cables entrained throughsaid hollow barrel portion, said first operating cable having a firstend connected to said first end of said shuttle and a second endconnected to said trigger mechanism; a return mechanism connected tosaid shuttle for moving said shuttle to said first position; and saidsecond operating cable having a first end connected to said second endof said shuttle and a second end connected to said return mechanism. 17.The suturing device as defined in claim 16 in which said biasing meanscomprises a compressible, expandable elastomeric member.
 18. Thesuturing device as defined in claim 16 in which said needle is providedwith a multiplicity of circumferentially spaced-apart notches that areso constructed and arranged as to be engaged by said needle engagingmember as said needle engaging member moves within said cavities. 19.The suturing device as defined in claim 18 in which said needle isgenerally rectangular in cross-section.
 20. The suturing device asdefined in claim 19 in which said first end of said shuttle is providedwith a generally conically shaped opening for receiving said chamferedend of said needle.
 21. The suturing device as defined in claim 20 inwhich said needle has a generally planar surface lying within a planeand in which said second end of said needle is provided with an apertureextending generally perpendicular to said generally planar surface. 22.The suturing device as defined in claim 21 in which said needle isconstructed from plastic.
 23. The suturing device as defined in claim 21in which said return mechanism comprises biasing means connected to saidsecond operating cable for urging movement of said shuttle from saidsecond position toward said first position.
 24. A suturing devicecomprising: (a) a head portion operably associated with said grippingportion, said head portion comprising: (i) a body having a shuttletrack; (ii) a shuffle operably associated with said body for movementalong said shuttle track between a first position and a second position,said shuffle being provided with a needle guide and at least one cavity;(iii) a needle carried by said shuttle for movement along said needleguide between a first position and a second position; and (iv) a needleengaging member carried in said at least one cavity for engagement withsaid needle to control movement of said needle along said needle guide;and (b) operating means operably associated with said head portion formoving said shuttle between said first and second positions, saidoperating means comprising: (i) an advancing mechanism operablyassociated with said shuttle for moving said shuttle to said secondposition; (ii) a first operating cable having a first end connected tosaid shuttle and a second end connected to said advancing mechanism; and(iii) a return mechanism connected to said shuttle for moving saidshuttle to said first position.
 25. The suturing device as defined inclaim 24 in which said operating mechanism further includes a secondoperating cable having a first end connected to said shuttle and asecond end connected to said return mechanism.
 26. The suturing deviceas defined in claim 25 in which said return mechanism comprises biasingmeans connected to said second operating cable for yieldably resistingmovement of said shuttle to said second position.
 27. The suturingdevice as defined in claim 25 in which said shuttle is provided with aplurality of circumferentially spaced cavities and further includes aneedle engaging member carried within each of said circumferentiallyspaced-apart cavities for movement within said cavities in response tomovement of said shuttle between said first and second positions. 28.The suturing device as defined in claim 27 in which said needle issemicircular in shape and is provided with a plurality ofcircumferentially spaced-apart notches that are so constructed andarranged as to be engaged by said needle engaging member as said needleengaging member moves within said cavities.